Pulse Pressure and BP
Posted , 6 users are following.
21 year old, female. Diagnosed with High BP. I also run a pretty high heart rate, as high as 155.
I'm currently on metoprolol and bouncing between 50mg and 25 mg. The 25mg is not enough to bring my heart rate down and the 50 mg lowers my blood pressure to almost dangerous levels. I start getting dizzy and almost passed out a couple of times.
I was feeling very dizzy while laying down and so I took my BP. 118/43. And then I found this thing called pulse pressure.
I subtracted the two numbers and got a PP of 75! According to some studies, it should actually be 40. Oh my god.
But all the studies seem to only concern older people and men, so I'm not even sure if this applies? Nonetheless, I'm freaked out!
I stood up and took it again. Can't remember my BP, but my PP was around 55. Better.
But am I going to be okay? I've talked to a cardiologist about how low my BP goes, but she didn't seem so worried. I even told her it made me feel dizzy and she just said to take some salt water. Which is annoying to do after a while. Like, every night it's like this. It has even erupted my sleep. And well I guess she must not be worried about pulse pressure. If she even calculates that at all.
Sorry... I'm going on a vent here, but this is truly frustrating. I've been dealing with this for months now and I have no idea how both my BP and HR got so high. It all just came out of nowhere, and so far my blood tests are normal.
Had EKG, Stress Test, and Echo as well. All normal. Aside from mild MVP which my cardiologist isn't even concerned about it.
I'm trying to push to see and endocrinologist, but either my primary doctor doesn't care or my insurance is very limiting. I have to have a "reason" to see an endocrinologist. I have to have a blood test first. Maybe that's a thing, but... I mean... isn't my history is high BP and high HR enough of a reason to see a specialist?
I really do believe I have a thyroid problem or something and I know blood tests can be normal even if you have thyroid problems.
It's all frustrating, slow, and depressing. I can barely move around without feeling dizzy and I just want to give up.
I also have shortness of breath too but only god knows why. I've been to the ER more times than anyone. Tons of blood tests, been monitored, etc... and nothing.
I'm very dizzy atm, which I probably should go to the ER again, but... it might be nothing.
0 likes, 31 replies
tyler04178 danisha70256
Posted
Might seem off topic but there's a reason I'm asking and I'll explain after you reply. Have you noticed any vision changes recently?
danisha70256 tyler04178
Posted
Sometimes when my BP gets too low yes. But overall, my vision is fine. Sometimes, my right eye would go dim I guess, like when getting up from bed or something, but then it goes back to normal so I have no idea what that's about.
I've had several ct scans of the brain as well. All normal.
tyler04178 danisha70256
Posted
There is a condition that causes similar hypertension issues that you are dealing with called idiopathic increased intracranial pressure. In short it's where the spinal fluid pressure is elevated and it causes your blood pressure to rise and drop but also it causes intermediate dizzy spells. With this condition if you get up from a laying down position even a little bit too quickly you will have intermediate Deming of your vision in one or both eyes as well as dizziness and some people have been known to pass out or get a feeling that they are going to pass out. Also when you cough or sneeze you'll have these symptoms. maybe this is something you could bring up to your doctor. Good luck with everything
AlexandriaGizmo danisha70256
Posted
jx41870 danisha70256
Posted
Well the hypotension is an issue, since you don't want to be falling over. And the tachycardia is an issue at that level. It's sufficiently unusual that I hesitate to give even what little I know. It could some or all be related just to electrolytes - salt water might raise your diastolic a little, if that's the problem in the first place. I'd also worry about potassium, the simplest source of which is bananas! I also like our sea-salt potato chips ('crisps"
, if I feel a need for electrolytes. And I guess make sure of your magnesium too, a little in the sea-salt, more in almonds.
?So, if your diet somehow misses all these, or you have other issues, maybe there's a quick and easy fix, or at least a mostly natural fix. Meanwhile, if you need an excuse, dark chocolate - best if it's 70% or more, and most people say it should have no milk in it at all - is a natural beta blocker and can lower your pulse rate for a few hours, have an ounce or two of the dark stuff. It works pretty well for me.
?Hope that's all it takes, best wishes!
Bob37393 danisha70256
Posted
In hospital emergency departments pulse pressure is of no importance.
?What is critical, particularly in your case, is your Mean Arterial Pressure (MAP) which is normally between 70 mmHg and 110 mmHg.
?For normal heart rates (between 60 to 100 beats per minute) this is calculated as:
(systolic + (2 x diastolic))/3
So in your case when dizzy this would be:
?(118 + (43x2))/3 = (118 + 86)/3 = 68 mmHg
providing you are neither bradycardic (<60) nor tachycardic(>100).
?A MAP of at least 60 mmHg is necessary to provide sufficient blood flow to your major organs which means you are slightly below the normal range and explains why you feel dizzy when you stand up when a lot of blood drains down towards your lower limbs.
jx41870 Bob37393
Posted
Hey Bob, I like that MAP business, never seen it before.
I've long simply added the two numbers and gone with the sum, with an up-arrow or down-arrow based on the diastolic - if the systolic is a higher percentage above normal I discount it with a down arrow.
Of course the two numbers from any reading have basically independent degrees of freedom, one might be few points higher than reality while the other is lower, etc, and this helps to get the most value from individual readings.
Bob37393 jx41870
Posted
Hi jx.
?Mean Arterial Pressure (MAP) is something that primary care physicians are unlikely to care much about because studies of blood pressure treatments have always mainly involved controlling systolic blood pressure (SBP)because it's easier to measure.
?Because the target for SBP has been decreasing over the years this has resulted in consequential reduction of Diastolic Blood Pressure (DBP) which if not spotted early enough results in reduced blood flow to the heart (low perfusion) with consequential likelihood of heart failure symptoms.
?Treatment of reduced cardiac output through drug therapy necessitates controlling MAP rather than SBP. This is recognised in specialist cardiac medical circles.
?
jx41870 Bob37393
Posted
Bob, that's all very interesting, makes a lot of sense. I've seen a couple of specialists, or so they said. I'm very much afraid the science behind all of this is so feeble, being a "specialist" hardly matters. Need a specialist who is a really good specialist, not just the specialist next door. I've known this about medical care in general for a long time, the average level is just not that good, and you know what - half of them are below average! But it's hard as a patient to judge.
Bob37393 jx41870
Posted
Your comment on degrees of freedom reminded me of a graph I produced showing the independent parameters of systolic, diastolic blood pressures and heart pulse rate that would be necessary to maintain a reasonable Mean Arterial Pressure (MAP) of 120 mmHg.
?Here is the bar graph which shows that theoretically, systolic pressure can rise to over 350 mmHg when diastolic drops to near zero (this may be achievable for a short period of time like when you're weight lifting and blood pours out of your nose but in the longer term you're dead).
?On the other hand column 26 shows the point at which systolic=diastolic pressure. This is nearly achievable as in hibernation when just a small pulse pressure (systolic minus diastolic as danisha has found) is needed to keep the heart going - otherwise if there's no pulse pressure you don't get any blood circulation (perfusion) and you're dead again.
?There is an assumed constant in the graph of heart rate as 60 bpm.
?Interestingly, the realistic resting value heart rate (RHR) is 60 beats per minute with blood pressure 150/105 which in my opinion is an achievable value without medication.
Many years ago this used to be the target my doctor gave me but unfortunately it has dropped to 120/80 under WHO recommendations which in some circles is reckoned to be driven by the pharmaceutical industry.
?Everyone's different, but I couldn't maintain 120/80 on the cardiac ward without the ecg alarm going off - although this to some extent could have been due to my sleeping position.
jx41870 Bob37393
Posted
Bob,
?Can't seem to see the chart, just the thumbnail, but I get the idea.
?Yes, I know I should discount the syn/dia numbers for some slight tachycardia, but not really sure what to do - for me the tachy (about 90 to 120) seems to make the pressure numbers run lower. Which is cause, which effect? I dunno.
?I keep hoping a doctor will pitch in something intelligible, but my luck just keeps running poor on that.
Bob37393 jx41870
Posted
The bar graph shows how ?systolic and ?diastolic blood pressures must change for a heart rate, ?p, of 60 beats per minute (the gold standard for electrophysiological measurements) to achieve a constant Mean Arterial Pressure of 120 mmHg. This has been derived from a cardiac textbook equation which shows the interrelation between s, d and p.
?Written as f(s,d,p) = 0 subject to MAP being 120 mmHg.
?I can't see how doctors can work this out without a mathematical assistance.
Bob37393 jx41870
Posted
Hi jx,
?Danisha and I have exchanged PMs and I have been able to establish from her recent EKG that her interval QT is borderline between normal and short. Short QT Syndrome (SQTS) is formally diagnosable for a female when a corrected factor, QTc (the estimated QT at 60 beats per second) is below 370 ms.
?However, an ambiguity arises because we don't know what her QT actually is at 60 bps and we also don't know if the medication she has been taking has reduced a normal QT value into the SQTS range. Her symptoms are consistent with having SQTS when a range of medical tests prove normal.
?Interestingly your contribution to this thread is highly relevant because electrolyte balances underlie the shortening of the QT value as shown in the attached image (but I don't think you can enlarge it).
?Unfortunately knowledge about diagnosis and treatment of SQTS has only evolved in recent years and many medical professionals are unlikely to have met it because it's so rare.
?This might explain my latest replies in this thread.
?Thanks for your input.
I'm just hoping Danisha can find the resources to get a definitive answer to her health problems.
edwin76622 danisha70256
Posted
Bob37393 danisha70256
Posted