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Help Finding An Article On Pulse Pressure


Batik

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Can someone please find me a medical article on pulse pressure that I can print out and give to doctors? Something that makes it clear that having a pulse pressure of 8 is NOT normal, and explains why. Right now I almost never come across medical professionals who have even heard of PP, and earlier today I had a heart helpline nurse tell me that the reading of 94/86 during my TTT can't have happened, must have been an error, even when I pointed out that the previous reading had been 86/76. PP was the main sign that went wrong during my TTT, so it's the one I think I need to concentrate on.

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Batik,

My pulse pressure is always less than 40, most of the time is 20.

This is from Mayo:

The numeric difference between your systolic and diastolic blood pressure is called your pulse pressure. For example, if your resting blood pressure is 120/80 millimeters of mercury (mm Hg), your pulse pressure is 40 — which is considered a normal and healthy pulse pressure.

A high pulse pressure may be a strong predictor of heart problems, especially for older adults. Generally, a pulse pressure greater than 40 mm Hg is abnormal. A pulse pressure lower than 40 may mean you have poor heart function, while a higher pulse pressure may mean your heart's valves are leaky (valve regurgitation).

http://www.mayoclinic.com/health/pulse-pressure/AN00968

also:

http://www.pdiconnect.com/content/30/3/265.full

Hope these will help.

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Thanks for those. I read the first and skimmed the second (very fuzzy-headed today), and they seemed to be talking purely about high PP. Do you know of any sources on low PP? I've had high PP too, 90 was the highest I've recorded, but since I was the one recording it, it doesn't count. My GP has made it abundantly clear that my home BP readings don't count.

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Guest Alex

Hi Batik,

this is of the few, if not the only POTS article that I have read that mentions the pulse pressure (but my memory might be playing tricks on me)

http://www.medscape.com/viewarticle/705183_1

Postural Tachycardia Syndrome (POTS)

Phillip A. Low, M.D., Paola Sandroni, M.D., Ph.D., Michael Joyner, M.D., Win-Kuang Shen, M.D

"Clinical examination reveals an excessive HR increment. Pulse pressure may be excessively reduced and there is marked beat–to-beat variability of both pulse pressure and HR." on page 2, Clinical Features.

You need to create a free medscape account in order to access the article though. If you prefer you can PM me and I'll fwd you the entire article.

Some other articles that may be of interest to you

http://www.pps.org.pk/PJP/3-2/07-Farida.pdf

DETERMINATION OF CARDIAC OUTPUT IN MEDICAL STUDENTS BY PULSE PRESSURE METHOD

"Narrowed pulse pressure less than 30 mmHg could be due to tachycardia, severe aortic stenosis, constrictive pericarditis, pericardial effusion, ascites."

http://www.cvphysiology.com/Blood%20Pressure/BP003.htm

Arterial and Aortic Pulse Pressure

http://www.buzzle.com/articles/narrow-pulse-pressure.html (not exactly a reliable source though)

* Hypovolemic shock caused due to low blood volume owing to an injury could also affect the readings.
* Aortic stenosis is one such condition that is caused due to the narrowing of the aortic valve. When the aortic valve that controls the flow of blood from the left ventricle to the aorta and to the other parts of the body becomes constricted, sufficient amounts of blood is unable to leave the left ventricle during the systole. This causes lowering of aortic pressure during systole.
* Narrowing of the mitral valve (valve is located between the left atrium and the left ventricle) could also affect the reading. When the blood that moves from the left atrium to the left ventricle during the diastole, is unable to pass freely due to the constricted mitral valve, blood accumulates in the left atrium, thereby increasing the diastolic pressure.
* Cardiac tamponade (compression of the heart due to accumulation of blood in the space between the heart muscle and the pericardium), constrictive pericarditis (long-term inflammation of the pericardium that is characterized by scarring and loss of elasticity of the pericardium), pericardial effusion (accumulation of excessive amounts of fluid in the pericardial cavity), ascites (accumulation of fluid in the peritoneal cavity) and tachycardia (abnormally rapid heartbeat) could also be contributory factors

I hope these help.

Best,

Alex

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It's my understanding that narrow pulse pressure is indicative of stoke volume. I assume that is why mine narrows when I stand and widens way out when I lay down. I've also noticed the more narrow mine is the worse I feel. I think it is demonstrating poor blood return to the heart due to pooling when we stand

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To make it a bit clearer, my problem is that I didn't happen to get tachycardia during the TTT. I'm not entirely sure why. I don't get it every single time, and on this occasion I'd had an anti-nausea tablet about 7 hours earlier which I realised halfway through the test is also an anti-vertigo tablet. So when I talk to my GP or the cardiologist, assuming I even get a return appointment with the cardiologist, I will probably be told that I failed the TTT and there's no reason for me to continue seeing them. It'll be my job to convince them that the results warrant further investigations. I was moderately symptomatic, but so far they've been pretty uninterested in symptoms.

In other words, "tachycardia causes narrow pulse pressure" probably won't be the best line to take, since I didn't get tachycardia that time. I don't think it helps that I was only allowed to lie down for 5 min before the test. My BP was only taken every five minutes, and apart from that and the HR monitoring, there was no other monitoring done. They just stood me up for 45 minutes and that was it. No nitroglycerine either.

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I should mention that I'm appreciating all these articles! Unfortunately I'm really brain-fogged at the moment, and my PDF viewer is playing up so that I'm finding it next to impossible to read PDF files at the moment. (Adobe Acrobat Reader - does anyone know what's up with that?) So I'm concentrating on the ones I can make sense of right now.

The last one is interesting. The diagnostic criteria are a little different, I noticed: 35bpm rise instead of 30bpm, or above 115 instead of 120. Does it matter that it's about children? I'm nowhere near adolescent, being 35.

How is it normal to interpret a TTT? Is it done purely on HR? If BP is part of it, at what level do they consider BP changes to be noteworthy? What about symptoms? They were writing mine down, although apparently they thought that if I mentioned a symptom near the start and not later on, that meant it stopped. Thankfully that came up in the discussion afterwards, so I could tell them that no, the visual symptoms persisted throughout the test, I just didn't want to be talking all the time.

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They look at both BP and HR. A drop in BP is considered significant if its greater than 20 systolic or greater than 10 diastolic. What it means depends on the degree of the drop, when it occurs during the test, whether it's fleeting, sustained or worsening, how it correlates with your HR, etc. I think symptoms probably only matter to the extent that they correlate with your vitals (used to determine pre-syncope, etc) If you're symptomatic but your vitals are normal it would be hard for them to determine if the test is causing your symptoms or it's just a coincidence.

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Guest Alex

Batik,

to the best of my knowledge, the dx criteria for POTS in kids/adolescent have been recently redefined - not sure if everyone in the medical world agrees with the new ones or not, but they are slightly different than those for adults. Regardless of that the POTS criteria for adults are an increase in HR of 30+ bpm or a max HR of 120+ bpm.

Also, in my case the first TTT I had was deemed 'abnormal' based on several findings: an exaggerated increase in HR upon tilting, a large drop in BP couple minutes after they tilted me, and a syncopal episode while upright. I believe they are looking at several things during the tilt test: HR response, BP response, symptoms, catecholamine levels supine and upright (if your TTT includes measuring them - mine did). I don't have specific numbers in mind though for the BP.

Sorry I can't give you another link for the PDF article. What helps me if I get technical issues with Acrobat Reader is restarting my device - see if that solves your problem. Also, I update the reader from time to time, but that shouldn't be an issue.

Hope you feel better.

Alex

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The Adobe Reader problem's been there for a week or so, so rebooting won't help. Good point about updating, I'll try that.

Here's what happened during my TTT last week:

1. Temperature problems - feet and hands got colder, torso got very hot and sweaty.

2. Breathing problems - particularly bad at start, then on and off for the rest of the test.

3. BP drop - 115/85 or thereabouts when lying down, lowest was 86/76 standing, lowest PP was 94/76. Wasn't always that low, though, it went up and down. They were only checking it every 5 min. In my experience, it goes up before it goes down, but then I check it every minute if I'm doing a poor man's TTT.

4. Dizziness - I can't even remember if I bothered to comment on this, it's something I regard as normal by now. Drat.

5. Visual disturbances - started after a few minutes. Floaters etc. rather than a full blackout.

6. Convulsive jerking - started halfway through the test and kept on going on and off for the rest of it.

7. Muscle pain - particularly around head and shoulders. I had trouble keeping my head still, they kept having to mess around with pillows. Between that and the jerking, I don't think I stayed very still for the test. A lot of this will be because I have severe ME and had overdone it for the few days beforehand, on the cardiologist's instructions.

8. Itching - very mild, not even sure if it happened at all. This is unusual for me, normally I get intensely itchy if I stand still.

9. Heart rate - didn't get the numbers, but I could tell it hadn't gone up much, and they confirmed this when I asked. I have no idea why that one's so inconsistent for me, unless it was due to the prochlorperazine I'd taken about seven hours earlier.

Unfortunately, I think I'm going to be told I failed the test, that this wasn't enough. I failed the Holter monitor because I did faint. This is getting farcical.

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It is all so odd my son's Dr. told us that son's symptoms are related to son's diagnosis of Ehlers Danlos syndrome not POTs and the Dr. also said my son's chronic fatigue is just that chronic fatigue and again not POTs related. Oh my head really does hurt with all this confusion going on.

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Guest Alex

The one thing that strikes me as odd is the way the measured your BP - during my 2 TTT's my BP was monitored constantly with a device called a beat to beat blood pressure monitor attached to the fingers - not every 5 min so they captured all the fluctuations.

Regarding prochlorperazine - I had an awfully nasty reaction to it - borderline serotonin syndrome, and my HR and BP was all over the map in my case for a couple of hours after I took that (never again), not sure how it could have affected your results.

As far as the rest of your symptoms - it is odd that your drs would dismiss them, as they seem quite common with POTS.

Ever considered a different dr or a different testing facility? I can see how frustrating this is for you.

Best of luck and keep us in the loop.

Alex

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