Re: Blood Pressure Sound Change

Posted By kd on July 08, 1999 at 12:09:27
I am supposed to take my blood pressure at least once a day because it is resistant to anti-hypertensives.  I am currently on Lozol, Cardazem CD, Zestril, Catapres Patch among other medications for other things.  I am 48 yo, 5'3", 93 lbs, never smoked or drank alcohol, have atherosclerosis obliterans, 3+ mitral valve regurg, some sort of liver lesion, and a history of carotid disease and TIAs.  Cholesterol never over 210 but is about 135 with Lipitor.  Untreated (beyond Cardizem CD) BPs were averaging about 165/35 with periods of systolic mostly between 170-225 (once to 300).  Since all the meds, averages 135/30 with periods over 150/0.  Most of the time, my diastolic is 0 and never over 35 in the last year.
Questions:  
1. Is it dangerous to have such low diastolic ratings?  There is always at least 100 pts between it and the systolic, is this significant?  What does it indicate?  
2. Can a liver lesion cause BP problems?  Atherosclerosis?  The only thing they know for sure is that it is fluid filled.  No tests have been able to identify it.
3. The main question is, as I said, I have to take my BP frequently.  I use a stethescope that has been calibrated with my GP's.  Usually the sound was  a sort of softer thunking sound but then it became much more definite with a very difinitive thunk with each beat in the past few months.  I wasn't worried about that because it was just louder and according to nurses, sometimes you can hear my heart without putting the stethescope on my arm.  What it is doing now, is creating a hollow sound with each beat.  No thunk.  This is very different and I can't explain it other than to say it is "hollow," like when you tap a ripe watermellon instead of an unripe one, or a wall where there is no stud vs where there is.   Is this diagnostic?  Should I bring it to the attention of my doctor?
Thanks so much,
kd

[CCF CARDIO MD DLB]

Posted By CCF CARDIO MD - DLB on July 08, 1999 at 14:57:09
Dear kd
A diastolic blood pressure of 0 is impossible - it is incompatible with life. Either you or your doctors or both are measuring your blood pressure incorrectly or with bad equipment. The wide difference between systolic and diastolic blood pressures can be seen in aortic regurgitation (though you wrote that you have mitral regurgitation). I think your liver problems are unrelated to your other problems. I do not know what to make of the blood pressure sounds, as I am skeptical of your blood pressure measurements. I think you should see a cardiologist to have the entire situation - blood pressure measurements and valves - reviewed.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

[kd__0__0]

Posted By kd on July 08, 1999 at 17:24:07
The diastolic BP has repeatedly been cited as O in the hospital in 1978, and then very often in the hospital, by doctors, nurses, specialists, cardiologists, neurologists, you name it - including professionals at CCF.  It startles most but they document it.  The reading observation is not just mine and was commented upon before I was aware of it.  I think I am alive.  Unless it is one of those science fiction things.  Once a neurologist at CCF commented when I had the reading of 300/0 after a very short step exercise that I needed to have my pressures read in a different way but she never said how.
Ok, on the comment re: the liver.  
Question from seeing something on the internet:  Can Lipitor cause muscle breakdown?  I've been having problems with muscle wastage and bruising and wonder if it can be connected.
I will try to make an appointment with the cardiologist.  I'm in transfer between GPs and the cardiologist is at CCF but I have to go up there anyhow so I'll see what I can do.  It won't be for several months though.  Unless you think it should be sooner.
Thanks much - again.
kd

[CCF CARDIO MD DLB]

Posted By CCF CARDIO MD - DLB on July 08, 1999 at 17:38:01
Dear kd
Blood pressure measurement is actually quite complex. Stiff, calcified arteries or valve problems like aortic regurgitation can make recording an accurate blood pressure with a cuff very difficult. A diastolic blood pressure of 0 cannot occur in life. However, using a blood pressure cuff and stethoscope, it is possible to be fooled into thinking a diastolic blood pressure is 0, because of turbulent blood flow in the artery causing a variety of sounds, that do not go away as the cuff is deflated. I suspect this is the case with you, as you wrote that the nurses said they could hear a sound in your arm even without inflating the cuff.
Lipitor can definitely cause inflammation of muscles; a simple blood test can check for this and you should see your doctor about this soon.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.











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Blood Pressure Sound Change kd 7/08/1999
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Re: Blood Pressure Sound Change CCF CARDIO MD - DLB 7/12/1999
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