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Forum Name: Cardiology Symptoms

Question: Low Pulse Pressure - Very worried!


 tiffairy - Wed Mar 12, 2008 7:21 pm

I'm a 28 year old female with prior history of benign heart arrythmias. Normal cardiac stress test 2 years ago, normal echo 1 year ago, and normal ECG 1 month ago. I have had intermittent episodes of high blood pressure associated with stress which last only minutes at a time. I am on no medication.

I was recently ill with some sort of stomach thing that caused me to vomit about 10 times in 12 hours and have a few bouts of diarrhea. I became pretty dehydrated but recovered in a few days. I'm listing this because it's when I first noticed this problem although I don't know if it is related or not.

I've been having a low pulse pressure for 2 and a half weeks now. It occurs when standing and after exercising. The most troublesome reading I've gotten was probably 98/83 and there have been variants such as today when it was 108/90. I've also seen 96/76. When I rest, my pulse pressure returns to normal with a blood pressure reading in the range of 105/65. My heart rate is also elevated with activity and standing though this is not terribly uncommon for me. It's been about 110-135 during these periods of low pulse pressure though I've seen it be 85 during a low PP as well.

My doctor is out of town this week and the nurse didn't seem to know what to say. She is having me come in to see the Nurse Practitioner on Friday but I don't feel very comfortable that I am not seeing a doctor for what I perceive as a possibly life threatening problem.

I read online that causes are heart failure, aorta problems, the list goes on but none are good and are all life threatening conditions.

So I guess my question is - is there ever an instance where this doesn't mean something really amaizingly horrible? Could it be a normal finding or caused by
something far less scary than heart failure?

And is it safe to wait until Friday and then see Nurse Pracitioner or should I got to the hospital so I can see a doctor right away?


I am really really really scared right now, please respond soon.

Thanks.
 tiffairy - Fri Mar 14, 2008 12:28 pm

Update!

I canelled my apointment with the Nurse Practitioner in favor of waiting until Monday to see my Cardiologist. However, I am still concerned I should be at the hospital and therefore cancelling the appointment was a very bad idea.

Still anxiously awaiting a reply.
 John Kenyon, CNA - Wed Jul 23, 2008 11:20 pm

User avatar Hi tiffairy -

Well, hopefully by now you have your answer, but in case you don't, and for the benefit of others who may read this thread, the short answer is that this doesn't mean something really amazingly horrible. In fact, your blood pressure readings are all well within the range of normal. The fact that your pressure drops on standing is not at all unusual, and may be due to an benign phenomenon known as orthostatic hypotension (but very, very mild) or could be just because you don't wait a full minute after standing (as per medical protocol) to take your standing pressure. Your heart requires a minute at least to adjust to the change in posture. Still, the pressures you report here are perfectly fine. They would have to be a lot lower to even cause a second look.

Also, upon standing, one's heart rate will usually pick up anywhere from 5 to 20 beats per minute, especially during the first minute after standing. While the textbook norm for blood pressure and rate one minute after standing is an increase of 10 points in systolic pressure and about 10 beats per minute, this varies from person to person. We're not all exactly alike in this respect. There is a range of normal, as with most vital signs.

You strike me as possibly an anxious person, and it probably would be a good idea (if possible) for you to pay less and less attention to what your heart (and body in general) is doing, unless you are first experiencing disturbing symptoms. Then they should be evaluated by a medical provider; you definitely aren't doing yourself any favors by trying to check your own hemodynamic status unless you have special medical training.

Hopefully by now you've been to the nurse practitioner and have been reassured about your pressure and pulse variations. Hopefully this will help you or someone like you who may read this. Good luck to you.
 moneysaver3 - Wed Jun 30, 2010 7:51 pm

John,

Might I suggest that you only give advice if you are 100% sure what the poster is talking about?

She is not talking about low BLOOD PRESSURE. She is talking about low PULSE PRESSURE. There is a difference. A HUGE difference.

Also, it's not really a good idea to tell someone to quit being stressed and to quit focusing on their body! That's not your job! You have not seen that person personally and shouldn't be saying such things!

The reality is that low PULSE pressure (which she CLEARLY DOES have) IS something that can be of concern. It might not be, but it CAN be!

Amy
 Dr. Tamer Fouad - Sat Jul 03, 2010 6:20 am

User avatar Hello Amy!

Thank you for your input. However, I am a little disappointed at the way you chose to express your concern and opinion. John, like everyone else here is a volunteer that tries his best to answer questions to the best of his knowledge for free. His work here is appreciated by everyone.

You have made an interesting comment which is why I am responding back. The definition of pulse pressure is directly related to blood pressure. The pulse pressure is defined as the systolic minus the diastolic pressure. One definition of the normal range for pulse pressure is between 25-50% of systolic blood pressure. Widened (elevated) pulse pressure is much more important with blood pressure readings taken from the general population (screening). These can indicate stiffening of the major arteries or conditions with increased cardiac output / hyperdynamic circulation.

In contrast, a low pulse pressure (definitions in the literature vary from 40 to 45mmHg) is only relevant in the setting of acute decompensated heart failure and possibly also in congestive heart failure. But, let me stress: in these two settings the low pulse pressure is important not from a diagnostic point of view but only from a prognostic angle. We NEVER diagnose these conditions by using low pulse pressure. This is because low pulse pressure is neither specific nor sensitive as a diagnostic test for these conditions. However, the finding of low pulse pressure in a patient with acute decompensated heart failure is related to the patient's expected survival as suggested by some studies.

There are three issues with the post that I am sure John was completely aware of when assessing his response to this question.

First, the notorious inaccuracy of home blood pressure readings. In order to assume that a patient has any blood pressure disorder this should be done by trained personnel using a professional blood pressure reading device.

Second, the lack of consistency in the readings is extremely important. When we say low pulse pressure has a prognostic significance in patients with heart failure we mean a CONSISTENTLY low pulse pressure.

Third, for the sake of the argument, were we to assume the patient has a clinically significant and consistent low pulse pressure and that this COULD be somehow related to something as serious as heart failure then other symptoms would predominate. The patient must have a significantly low blood pressure and a very rapid heart rate. In addition to other failure symptoms such as shortness of breath, etc.

Let me take this opportunity to insist that no one here offers any medical advice. We hope to educate and inform our visitors by answering their questions. They are always referred back to their physician / provider who is the only person that can give advice.

I hope my answer has helped explain what this post was about. Please let us know if you have any more concerns.

Best regards,

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