Low pulse pressure

Introduction Blood pressure is divided into systolic and diastolic blood pressure, and the difference between systolic blood pressure and diastolic blood pressure is called "pulse pressure difference". For example, the systolic blood pressure is 120 mm Hg, the diastolic blood pressure is 75 mm Hg, and the pulse pressure difference is 45 mm Hg. Under normal circumstances, the pulse pressure difference of normal people is 20-60 mmHg (2.67-8.0 Kpa). If the pulse is more than 60 mmHg, the pulse pressure difference is too large, and if it is less than 20 mmHg, it is too small. Pulse pressure reduction is common: low blood pressure, pericardial effusion, severe mitral stenosis, severe heart failure and other diseases.

Cause

The common pulse pressure difference is mostly caused by the decrease of systolic blood pressure (high pressure). There are physiological factors and pathological reasons. The former is more common in systolic blood pressure and the body is thin or weak. The latter type is seen in shock and myocardium. Infarction, cardiac insufficiency, pericardial tamponade, adrenal insufficiency, etc. The organic lesions that cause a decrease in pulse pressure difference are pericardial effusion, constrictive pericarditis, severe mitral stenosis, and aortic stenosis. When it is found that the pulse pressure difference is significantly reduced, various organic lesions should be excluded first. If a detailed cause is not found, it is considered to be a decrease in constitutional blood pressure (mainly systolic blood pressure) and treatment of physical fitness. Low blood pressure, in addition to enhancing physical strength, appropriate strengthening of nutrition, but also to prevent dizziness, or falls when standing upright. Drugs can be used to regulate autonomic nerve function of oryzanol, vitamins, etc. for the phenomenon of small pressure difference without discomfort, Don't worry too much, because it doesn't have much impact on health.

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Under normal circumstances, the pulse pressure difference of normal people is 20-60 mmHg (2.67-8.0 Kpa). If the pulse is more than 60 mmHg, the pulse pressure difference is too large, and if it is less than 20 mmHg, it is too small. The pulse pressure difference is too small due to the decrease in elasticity and compliance of the surrounding blood vessels. The decrease of vascular elasticity is mainly caused by a large amount of lipid and calcium salt deposition in the subendothelium and proliferation of the smooth muscle layer of the middle layer of the intima. In addition to being regulated, these processes are also affected by factors such as age, gender, endocrine, lipid metabolism, and glucose metabolism.

In general, the greater the age, obesity, blood viscosity or diabetes, hyperlipidemia, the vascular elasticity is significantly reduced. The pulse pressure difference is too small in early patients with hypertension. Because the patient's sympathetic nerve excitability is increased, the whole body has small vasospasm, so that the systolic blood pressure is not high, the diastolic blood pressure is relatively increased, and the pulse pressure difference is small. Long-term blood pressure control is not ideal, the degree of arteriosclerosis is aggravated, systolic blood pressure is gradually increased, diastolic blood pressure control is not ideal, and finally, so-called classic hypertension with elevated systolic blood pressure and diastolic blood pressure will be formed. In patients with classic hypertension, the incidence of angina, stroke and other diseases has increased significantly. For treatments with too small a pressure difference, it mainly relies on softening blood vessels, dilating blood vessels, lowering blood fat, lowering blood sugar, lowering blood viscosity, preventing thrombosis, increasing capillary permeability and anti-aging.

Differential diagnosis

There are many diseases that cause small pulse pressure difference, and it is generally necessary to identify:

When the pulse pressure difference is significantly reduced, if a clear cause is not found, it should be considered to be a decrease in constitutional blood pressure (mainly systolic blood pressure). To treat constitutional hypotension, in addition to enhancing physical fitness and proper nutrition, it is also necessary to prevent dizziness or falls when standing. It can be treated with drugs such as oryzanol and vitamins which regulate the action of autonomic nerves.

The following diseases require further diagnosis:

1 myocardial infarction

According to typical clinical manifestations, characteristic ECG changes, and laboratory tests, it is not difficult to diagnose the disease. A painless patient is more difficult to diagnose. All elderly patients suddenly have shock, severe arrhythmia, heart failure, upper abdominal pain or vomiting, and the cause is unknown, or the original hypertension and sudden drop in blood pressure and no cause can be found, shock occurred after surgery but excluded For reasons such as bleeding, the possibility of myocardial infarction should be considered. In addition, elderly patients have heavier and longer-lasting chest tightness or chest pain. Even if there is no characteristic change in ECG, the possibility of this disease should be considered. All should be treated according to acute myocardial infarction, and electrocardiogram observation and serum myocardial enzyme assay should be repeated in a short period of time to determine the diagnosis.

2 aortic stenosis

(1) X-ray examination: the left heart is round and the heart is not big. Common aortic stenosis and aortic calcification. In the absence of calcification in the adult aortic valve, there is generally no severe aortic stenosis. In the heart failure, the left ventricle is obviously enlarged, and the left atrium is enlarged, the pulmonary artery is prominent, the pulmonary vein is widened, and the signs of pulmonary blood stasis are seen.

(2) Electrocardiogram examination: The electrocardiogram of the patients with mild aortic stenosis can be normal. Severe ECG left ventricular hypertrophy and strain. The increase in ST segment depression and T wave inversion suggests that ventricular hypertrophy is progressing. The performance of left atrial enlargement is more common. When the aortic valve calcification is severe, left anterior branch block and other various degrees of atrioventricular or bundle branch block can be seen.

(3) Echocardiography: M-mode ultrasound showed thickening of the aortic valve, the amplitude of the activity was reduced, and the opening range was less than 18 mm. The enhancement of the reflected light spot of the leaflets suggested valvular calcification. Aortic root dilatation, left ventricular posterior wall and ventricular septal symmetry hypertrophy. On the two-dimensional echocardiogram, the aortic valve systolic phase showed a concentric tangential motion and could identify congenital valvular malformations. Doppler ultrasound shows a slow and decreasing blood flow through the aortic valve and can calculate the maximum transvalvular pressure gradient.

(D) left heart catheterization: direct measurement of left atrial, left ventricular and aortic pressure. The left ventricular systolic blood pressure increased, the aortic systolic blood pressure decreased, and the pressure gradient increased as the aortic valve stenosis worsened. The pressure curve of the left atrium contracted was a high a wave. Should be considered in the following cases: young patients with congenital aortic stenosis, although asymptomatic but need to understand the degree of left ventricular outflow obstruction; suspected left ventricular outflow obstruction rather than valve causes; to distinguish aortic stenosis Whether combined with coronary artery disease, coronary angiography should be performed at the same time; multivalvular disease before surgery.

Under normal circumstances, the pulse pressure difference of normal people is 20-60 mmHg (2.67-8.0 Kpa). If the pulse is more than 60 mmHg, the pulse pressure difference is too large, and if it is less than 20 mmHg, it is too small. The pulse pressure difference is too small due to the decrease in elasticity and compliance of the surrounding blood vessels. The decrease of vascular elasticity is mainly caused by a large amount of lipid and calcium salt deposition in the subendothelium and proliferation of the smooth muscle layer of the middle layer of the intima. In addition to being regulated, these processes are also affected by factors such as age, gender, endocrine, lipid metabolism, and glucose metabolism. In general, the greater the age, obesity, blood viscosity or diabetes, hyperlipidemia, the vascular elasticity is significantly reduced. The pulse pressure difference is too small in early patients with hypertension. Because the patient's sympathetic nerve excitability is increased, the whole body has small vasospasm, so that the systolic blood pressure is not high, the diastolic blood pressure is relatively increased, and the pulse pressure difference is small. Long-term blood pressure control is not ideal, the degree of arteriosclerosis is aggravated, systolic blood pressure is gradually increased, diastolic blood pressure control is not ideal, and finally, so-called classic hypertension with elevated systolic blood pressure and diastolic blood pressure will be formed. In patients with classic hypertension, the incidence of angina, stroke and other diseases has increased significantly. For treatments with too small a pressure difference, it mainly relies on softening blood vessels, dilating blood vessels, lowering blood fat, lowering blood sugar, lowering blood viscosity, preventing thrombosis, increasing capillary permeability and anti-aging.

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