Question About Bp

[ed.lippman@gmail.com]

Finally saw Dr. Yan Go at UCLA. She was a wealth of information.

She asked me to get a BP monitor so I could do my BP in the AM laying down, then stand up and take my BP again. She wants me to track BP over two weeks to see if there's any drops or weirdness going on. She felt this is more accurate than a tilt table test.

This morning I took my BP. When I got up, I was really dizzy. My BP shot up but the pulse was exactly the same as laying down. Is this normal? Should it have gone up as well?

[friday7]

Finally saw Dr. Yan Go at UCLA. She was a wealth of information.

She asked me to get a BP monitor so I could do my BP in the AM laying down, then stand up and take my BP again. She wants me to track BP over two weeks to see if there's any drops or weirdness going on. She felt this is more accurate than a tilt table test.

This morning I took my BP. When I got up, I was really dizzy. My BP shot up but the pulse was exactly the same as laying down. Is this normal? Should it have gone up as well?

AS far as I know everyone has differing experiences. In my case my BP doesn't usually change a lot until I have been on my feet for a while. And my heart rate usually shoots up immediately upon standing. But that's just me. I know some people just have a high heart rate and normal or high BP so I imagine it could go the other way as well. I'm just guessing here though. I can only speak of my experience.

[Sophia3]

That kind of bp taking is NOT enough. That's more for orthostatic HYPOTENSION.

POTS is just heart rate escalation..with small or no variables in BP.

Others, as mentioned have DELAYED BP drop after being on feet a long time. Tell that Dr. to read the work of the late, great Dr. Streeten. Father of Dysautonomia. He is on the NDRF conference tape from 10 years ago. He mentioned having a patient stand all day LONG in his office with a nurse present.

Dr. Streeten said Patients don't tilt they stand!! But need to be monitored for long periods of time.

[McBlonde]

I am totally confused on this point regarding BP and HR. My heart rate shoots up sky high, but my BP drops to non-measurable within the first 3 minutes of standing. For instance, the last time I took a shower, I started getting a bad headache and nausea. I got out, measured my HR which was 168 and my BP had dropped too low to measure. That means, my HR is shooting up more than 50 points AND my BP is dropping at least 50 points.

Does that mean I have POTS with orthostatic hypotention or orthostatic hypotention with compensary HR increase?

[Heiferly]

If it's an electronic machine that is reading "Error" it may not actually mean that your BP is too low to measure, but that your pulse pressure is too narrow. Many of the machines will throw an error reading if the systolic and the diastolic BP are too close together. This happens not infrequently to patients with certain types of dysautonomia when they are upright. (I've nearly tossed my machine through a window for this reason.) If you call the company that makes your machine, they can usually tell you the lower limit of blood pressures it is guaranteed to be accurate down to; I was surprised to find that my machine was capable of taking extremely low readings (which left me with the conclusion that my "errors" were due to my unusually narrow pulse pressures).

[McBlonde]

If it's an electronic machine that is reading "Error" it may not actually mean that your BP is too low to measure, but that your pulse pressure is too narrow. Many of the machines will throw an error reading if the systolic and the diastolic BP are too close together. This happens not infrequently to patients with certain types of dysautonomia when they are upright. (I've nearly tossed my machine through a window for this reason.) If you call the company that makes your machine, they can usually tell you the lower limit of blood pressures it is guaranteed to be accurate down to; I was surprised to find that my machine was capable of taking extremely low readings (which left me with the conclusion that my "errors" were due to my unusually narrow pulse pressures).

Thanks! I didn't know that. It also happens with the one in the doctor's office that they use. Once when I fell out at the gym, the EMTs couldn't get a BP, but when the parametics got there, it they were able to get it at 52/48 (which was at least 5 minutes after I first went down.

[Heiferly]

Yikes! 52/48?! Were you still lying down? Did they take you in for IVs? Have you been tested for hypovolemia? Were you dehydrated at the time, or do your systolic and diastolic always stay that close together (pulse pressure narrow) even after you hit the floor and are supine for a few minutes?

[McBlonde]

Yikes! 52/48?! Were you still lying down? Did they take you in for IVs? Have you been tested for hypovolemia? Were you dehydrated at the time, or do your systolic and diastolic always stay that close together (pulse pressure narrow) even after you hit the floor and are supine for a few minutes?

Yep, I was standing there in the gym doing nothing but talking to the trainer. I told him I was feeling a little dizzy and they laid me down on the floor and propped my legs up. They freaked out when they couldn't get a BP and called 911. While waiting, they were pouring bottles of H2O down me. Then, the EMTs got there and I heard one shout to the other "I can't get a blood pressure." LOL, I was lying there thinking, that doesn't sound good! The paramedics arrived shortly and they got one at 52/48. When they got me in the ambulance, I remember the paramedic saying this is going to hurt and wow, was he right. He inserted a 16 gauge needle to get the fluids going wide open. They kept me in the ER for 2 hours with fluids running. They discharged me when my BP was 78/60. The discharge note said my dx was an anxiety attack. Crazy!

That was back in 2001....I just looked at my physician's follow up records and my BPS ran 78/58, 90/50, 90/62, 90/56, and 88/52. These were all sitting down. What does it mean when you have a pulse presure that's narrow?

[McBlonde]

Yikes! 52/48?! Were you still lying down? Did they take you in for IVs? Have you been tested for hypovolemia? Were you dehydrated at the time, or do your systolic and diastolic always stay that close together (pulse pressure narrow) even after you hit the floor and are supine for a few minutes?

Yep, I was standing there in the gym doing nothing but talking to the trainer. I told him I was feeling a little dizzy and they laid me down on the floor and propped my legs up. They freaked out when they couldn't get a BP and called 911. While waiting, they were pouring bottles of H2O down me. Then, the EMTs got there and I heard one shout to the other "I can't get a blood pressure." LOL, I was lying there thinking, that doesn't sound good! The paramedics arrived shortly and they got one at 52/48. When they got me in the ambulance, I remember the paramedic saying this is going to hurt and wow, was he right. He inserted a 16 gauge needle to get the fluids going wide open. They kept me in the ER for 2 hours with fluids running. They discharged me when my BP was 78/60. The discharge note said my dx was an anxiety attack. Crazy!

That was back in 2001....I just looked at my physician's follow up records and my BPS ran 78/58, 90/50, 90/62, 90/56, and 88/52. These were all sitting down. What does it mean when you have a pulse presure that's narrow?

[Sophia3]

I find doctors who OVER simplify things to be disturbing to those of us with true gravity inducing problems. I've gotten emails that Dr. Yan is not that helpful. From DINET's own website link is this which explains her approach. Might be worth a read and asking around to folks in CALIF who've seen her? Not trying to start anything here but if traveling is difficult/impossible due to nausea/expense, might want to take a gander.

http://www.dinet.org/physicians.htm#United%20States

[StacyRN]

That kind of bp taking is NOT enough. That's more for orthostatic HYPOTENSION.

POTS is just heart rate escalation..with small or no variables in BP.

Others, as mentioned have DELAYED BP drop after being on feet a long time. Tell that Dr. to read the work of the late, great Dr. Streeten. Father of Dysautonomia. He is on the NDRF conference tape from 10 years ago. He mentioned having a patient stand all day LONG in his office with a nurse present.

Dr. Streeten said Patients don't tilt they stand!! But need to be monitored for long periods of time.

Actually, BP has a lot to do with POTS, NOT just heart rate escalation. Dysregulation of the autonomic nervous system includes changes in vascular tone, which makes the blood vessels not respond to standing up like they are supposed to, by constricting to get the blood flow up to the heart and head. In the PD (partial dysautonomia) type of POTS (90% of POTS patients have this type), bp tends to drop and heart rate escalates when standing. It always seems to be worse in the morning, which is why the doc ordered her to check it in the morning. In the Hyperadrenergic type of POTS (10% of POTS patients), heart rate escalates AND bp rises, especially the diastolic pressure (the lower number), and sometimes the pulse pressure gets very narrow, like going from 120/70 lying down, to 115/98 standing up. This happens a lot to me, I have the hyperadrenergic type, where our bodies put out too much catecholamines (specifically norepinephrine). POTS is SO much more than just simply a high heart rate, or else being on a beta blocker to slow the heart rate would fix all our problems... but it doesn't. The fatigue, lightheadedness, brain fog, chest pain, etc. is still very real, and very disabling!

[StacyRN]

I am totally confused on this point regarding BP and HR. My heart rate shoots up sky high, but my BP drops to non-measurable within the first 3 minutes of standing. For instance, the last time I took a shower, I started getting a bad headache and nausea. I got out, measured my HR which was 168 and my BP had dropped too low to measure. That means, my HR is shooting up more than 50 points AND my BP is dropping at least 50 points.

Does that mean I have POTS with orthostatic hypotention or orthostatic hypotention with compensary HR increase?

I have to differ with this a little... how do you know your bp is dropping so low it's not measurable?? My bp won't read MANY times when I am standing up, and it may actually be HIGH! The reason it won't read is that my pulse is going so fast, and it is so weak and thready from the blood draining out of my upper body when I stand, that it can't capture all the heart beats, and thus cannot measure your blood pressure, so reads Error.

Watch the little heart beats on the monitor... if they aren't steady, start to skip, and then even stop altogether before it reads Error, it's because your pulse is so thready the monitor can't pick it up.

[StacyRN]

Also, a narrow pulse pressure means that the top number (systolic) lowers, and the bottom number (diastolic) rises, so the numbers get closer together, and it's hard for the heart to pump blood out to the body. Like a bp of 120/70 has a wider pulse pressure (pulse pressure of 50), but a narrow pulse pressure would be more like 115/100 (a pulse pressure of only 15!)

[Sophia3]

Stacy

Yes I know. I've the hyperadregernic pots and my BP can Spike BRIEFLY Initially whenstanding and I have to lie down to take it again. I also have LOW BP after resting, sleeping, trying to exercise. Was simply stating checking your BP ONCE immediately after standing is not enough. Yes it can wax and wane.

AGAIN I go back to Dr. Streeten, the father of Dysautonomia as many called him, who studied this stuff for many years. He came out of retirement to work again when he found Dr. Bell was getting many odd BPs in his CFS (Chronice fatigue pts)

But we could go on forever on the rare/normal specificities of dysregulation of BP/HR. Thus why one needs to STAND for long periods of time OR to have a "Proper tilt table test" which is "Properly interpreted".

Two different docs from same group interpreted mine WILDLY because I did not faint but one was a d&^*%&@ who knew nothiing of the Vanderbilt definiton of POTS which was my original answer to whomever I was answering.

Also folks you do not need to quote everybody when answering aquestion. It's tiring and I don't come here much due to eye issues that make words a challenge.

If you hit ADD REPLY you can just add to the topic. if you hit REPLY only it quotes entire posts or parts of them.

StillGettingARoundNewDinetSophiawithSoreEyes

Peace

:-D

[StacyRN]

Apologies, Sophia, I didn't mean to annoy you, point taken.

Hope you feel better.

Stacy