difference pressures in each arm

Posted by Paul Santos on June 16, 1999 at 12:01:53

Approximately 2 years ago I was diagnosed with mild hypertension I was hospitalized for about five days with Atrial fibrillation.
Since that time I have had a nuclear stress test and my heart appears to be in excellent shape with arteries clear (I am only 35 in otherwise excellent health).  My cardologist feels my hypertension is genetic.
More recently he has noticed my systolic pressure between my right and left arms shows a difference of 20 points.  He feels I might have a kink in one of my arteries which might be a birth defect. My EKG shows a negative T wave which has him puzzled.
Can you offer any other conclusions,  particularly regarding the difference in pressure between my arms?  I also suffer from "white coat syndrome"  My pressure is always higher when I am in his office.
Please advise
Paul S.

Posted by CCF CARDIO MD - CRC on June 16, 1999 at 16:21:02
The type of defect your doctor is referring to is called a coarctation and is a narrowing of the aorta before the take-off of the left arm artery.  Is it your left arm that has the lower pressure?  The test for this is a vascular duplex study and it can be confirmed with angiography.  If the coarctation is severe then surgical repair is necessary.   Has your doctor recommended any further testing?
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
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.
Posted by Paul Santos on June 17, 1999 at 13:07:07
Thank you for your comments.  My pressure is higher on my right side not my left.  What could be the cause of this condition?  I am currently on Verelan after about 2 years I have been getting dizziness and tingling in my hands.
I am thinking of trying an ACE inhibitor,  I am a little worried about side effects.  I am an actice 34 year old and exercise 3 or 4 times week.

Sincerely,

Paul
Posted by CCF CARDIO MD - CRC on June 17, 1999 at 14:40:52
It's possible to have a constriction on the right side but not as likely.  The test is still a vascular duplex.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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.
Posted by Paul Santos on June 17, 1999 at 15:09:47
Again thanks for your comments,  I have had a nuclear stress test,  would this test show any evidence of coarctation?  as mentioned the higher pressure is on my right side than my left. the systolic pressure is 20 points higher usually when I am stressed otherwise their is little difference!!
Also I have never had any evidence of a heart attack,  my blood pressure had been controlled for the past 2 years. Why would I still have an inverted T wave.
Also I would like to try an ACE inhibitor,  what are your thoughts?
Thanks

Paul

Posted by CCF CARDIO MD - CRC on June 18, 1999 at 08:06:31
A nuclear test won't show coarctation.  T wave inversion is a very non-specific sign and one I would not be concerned about.  As far as specific medication you should discuss this with your doctor.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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.
Posted by Doris on June 18, 1999 at 11:34:16
Dear CCF Cardio MD,  Paul Santos said his pressure was greater on the right side and not his left.  So that means his lower pressure is on the left which, if I am reading these posts correctly, according to what you said, then this is indictative of the coarctation.  If it is a narrowing of the left aorta then wouldn't the lower pressure be on the left side?  Perhaps it is I who is confused but you ask if it was the left side which had LOWER pressure and he answered "My pressure is HIGHER on my RIGHT side not my left." Am I correct or am I confused? Thank you very much.

Posted by CCF CARDIO MD - CRC on June 18, 1999 at 16:24:50
Dear Doris,
You deserve an A for observation.  You are correct and I am the one who got confused.  It is indeed a lower blood pressure on the left and a higher blood pressure on the right that is indictive of coarctation.  Paul, it looks like you really do need that vascular test.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
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.
Posted by Paul Santos on June 22, 1999 at 14:46:31
Thank you Doris!
My doctor is scheduling a Doppler Ultrasound,  will this show a coarctation of the aorta?  If I do have this problem why would'nt I have shown any other symptoms until now I am 34!(cold extremeties, weakness in legs etc?)
What other possible reasons could their be for for the difference in systolic pressure?  As I mentioned the diastolic pressure is about even.  I only notice a difference when my pressure is higher due to stress.
I am right handed by the way.
Thx,
Paul

Posted by CCF CARDIO MD - CRC on June 22, 1999 at 17:14:57
There are not too many other things that cause pressure differences between the arms.  A doppler is the right test but make sure they are aware of the diference and are looking for a coarctation.  A MRI may be necessary if it is not detected on the doppler.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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.
Posted by Paul on June 22, 1999 at 18:56:22
Could a stenosis be the reason for different pressures in each arm?
Wouldn't an echocardiogram show a stenosis?
My doctor could not detect a bruit with his stethoscope.
Is exercise dangerous with a mild stenosis or coarctation?
Thx,
Paul

Posted by CCF CARDIO MD - CRC on June 23, 1999 at 00:07:32
Could a stenosis be the reason for different pressures in each arm?
Yes, a stenosis is similar to a coarctation but is not present at birth.
Wouldn't an echocardiogram show a stenosis? Possibly.
My doctor could not detect a bruit with his stethoscope. Does not mean that it is not present.
Is exercise dangerous with a mild stenosis or coarctation? No.

I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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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