The pulse pressure is the difference between systolic and diastolic blood pressure. To work out your pulse pressure: systolic pressure minus the diastolic pressure. Eg: 120/80 is a pulse pressure of 40mmHg. 120 - 80 = 40. So 130/100 is a pulse pressure of 30mmHg. This is quite low and while some website state under 30mmHg is low pulse pressure other websites state less than 40 mmHg is rare.
Causes of narrow or low pulse pressure include shock, tachycardia, left ventricular dysfunction, hypovolemia, mitral stenosis, severe pulmonary stenosis, severe aortic stenosis, constrictive pericarditis, pericardial effusion, ascites, cardiac tamponade, congestive heart failure, anaphylaxis.
Excerpt below is from the article "Pulse Pressure....The Other Blood Pressure!" by Eva Martinez...
"It is very rare to get a pulse pressure reading of less than 40 mmHg. Chances are, if you receive one that is significantly lower, than you’ve just done the calculations incorrectly.
However, if the pulse pressure is genuinely low, it reflects a low stroke volume, which means your heart is not pumping out the amount of blood it is supposed to. This could be because of a very serious problem, such as congestive heart disorder or shock."
I think a head scan would be ideal in your case to rule out lots of other possibilities, and if you are scheduled for an echo, perhaps they can run a doppler echo on your carotid arteries in the neck while they are at it. These obviously feed blood to the brain. The more eliminations the better. However, it's important to realise it 'could' be more than one problem which often confuses issues because the symptoms of one problem often contradict the other.
Thanks to you both, for your help.
I would LOVE to get an MRI or CT scan. Alas, I have to convince a doctor to refer me. "One does not just walk into... ...an MRI/CT clinic."
After my echo., I'll likely push for that, now that I've had 2 more (very mild) episodes (after a 3 week respite of just individual symptoms). Today's episodes included uncomfortable scalp numbness/tingling radiating down to my right ear and cheek, cold hands and feet, palpitations, blurred vision, and an urgent need for a bowel movement. I'm still wearing a loop monitor, so I recorded & transmitted those episodes.
I have one or two symptoms of a number of conditions, but always missing something important. For example, I have never had true paralysis or numbness in limbs, nor a bad "headache", which tends to rule out TIA, for example. I have also never had a rapidly-beating heart rate, which tends to rule out SVT. There are so many others that have elements in common, but nothing fits exactly. I'm not just stumped. Now that I've had 2 more episodes (albeit mild), I'm still concerned for my welfare.
As for my pulse pressure, it is rare when it is not more than 30 points apart. It's usually below 100 and below 70. It is only above that when I'm checked in a clinical setting and/or following an episode. However, even then, my diastolic has only been 100 once (to my recollection). It has been below 100 every other time. (Often, the clinical reading is in the area of 120's over 90's.) So, I don't know what to make of that information at this time.
But thank you both, so much. Every little bit of information is what will help get me back to health. :-)
You don't have to have much in the way of symptoms with a TIA. My Father had 6 of them and only had some dizziness for a couple of minutes.
Re: TIA... That concerns me...but no one else, apparently. Virtually all healthcare professionals I've dealt with so far, have essentially dismissed my symptoms. Seriously. They either don't believe me, or just throw up their hands and say they don't know. My family doctor said, three times, at the end of my appointment, that my symptoms are, "...nothing."
TIA was my first concern, when the first episode happened. When that was completely dismissed by the first doctor I saw, I branched out into other possible conditions, like heart attack in women, irregular heart beat, SVT, HCM (even though I was tested for it just a few years ago, and the test was negative), but TIA was always in the back of my mind (pardon the unfortunate pun). Heck, I even considered a gluten allergy. But, of the so-called "common" symptoms of various conditions, none share the majority of my symptoms.
At ths point, I guess all I can do is hope I survive long enough to get more tests, in the hopes of preventing something even more serious. I was the picture of health five weeks ago. So much has changed...
Anyway, thanks for the additional info. :-)
Perhaps a change of Doctors? one who doesn't believe symptoms are imaginary or 'nothing'. Either that or I would just keep pestering the Doctor until they DO take you seriously. Don't get embarrassed by pestering them, it's their job to figure out the problem.
Thanks, ed34. :-) I appreciate the advice.
I'm one of those silly, health-conscious people who's always accepted the fact that doctors aren't psychics, and routinely see both hypochondriacs AND those with serious health problems. (meaning, people who try their patience, and people who are in much greater need of their services) Having never had a serious health issue before, I tended to avoid seeing a doctor, unless I felt it was necessary. (My former GP always had to get my file from his inactive files, the once-every-five-years I'd see him.) I look to whole foods and a healthy lifestyle as a means of preventing disease. I'd been lucky, 'til now.
Alas, my own doctor retired in 2005, just when I moved to a more rural area, where there are few (any?) doctors taking new patients. So,the first doctor I saw for this problem was also seeing me for the first time, at a walk-in clinic. The next trip was to a hospital ER, where the triage nurse basically decided I wasn't very ill. Five hours later, and not a single patient had yet been called from the waiting room, and I decided to go home (since my symptoms were long gone, at that point), having never seen a doctor. The next two doctor visits were also late-night trips to the ER. The first doctor was polite, but basically threw up his hands, once my ECG and CBC came back normal. (The nurses were dismissive, bordering on insulting.) The next ER doctor seemed willing to try, and was the one who referred me to a cardiologist for an echo. and the loop monitor I'm wearing right now. He also did a thyroid test. "My" (new) family doctor is actually my husband's long-time doctor. He is not taking new patients, but my husband coerced him into seeing me. He was the one who actually called my problem "nothing", but did send me for a stool analysis and 24hr Holter monitor.
My echo. is next week, when I return the loop monitor, after which I see the cardiologist for the first time. Results of the other tests will be sent to my new doctor, so I'll have to make an appointment to discuss the results. I suspect that will be about two weeks.
Unfortunately, the system here doesn't allow for much movement between primary care physicians, due to a shortage of doctors in my area. They have to be accepting new patients, and most aren't. On the other hand, there wouldn't be too much difficulty trying different specialists, since one's GP can just refer the patient to another specialst. The monkey wrench is, everything goes through the GP. But it isn't always easy to get a new GP. It's why so many walk-in clinics have sprung up (a lot of foreign doctors getting experience), and why so many people go to the ER for non-emergencies. (I'm one of them...kind of. I mean, I've gone because I was genuinely concerned for my life, late at night. Now that I've survived so many episodes, and all my tests have come back normal, I haven't been back to the ER. I just ride out episodes, and hope upcoming tests will discover the cause. But I would still go to the ER, if I really felt I was about to die...like I did with a few of my episodes. Make fun of me if they want, I think it would be dumber to think a stroke is happening, but too afraid to go to the hospital for fear of ridicule.)
I relocate often, so I hope when I move back to the city, I'll be able to find the family doctor I deserve.
TMI, I know. But thanks for taking the time. :-)
Ah, the good old reformation of the NHS. I would tell your cardiologist that your Doctor cannot determine your problem with regards to your symptoms. He may have a clue what the problem is, even if not heart. I'm sure he gets hundreds of patients every week and some are bound to have the same if not similar symptoms as yours. Please let us know how the tests go. I doubt if the technician doing the echo will say a thing. I've had ONE out of about 20 who has given some clues. The others all say "you will be told by the cardiologist". I mean, if they see a valve falling to pieces, what's wrong with telling you lol.
For the type of symptoms you have, there has to be something significantly physically wrong somewhere. I'm sorry the doctors aren't taking you more seriously. I think that if you just keep working through the possibilities, the answer is going to have to become apparent. I'm sorry it's not an easy answer. You will have to be persistent; I don't see any alternative to that. Fortunately, your echo is scheduled for next week, so if it is a valve issue, that test should pick it up, I would think. Good luck.
ed34, I'm not in England, but I get your meaning about the NHS. Ours is an annoying system, too, at times. And I specifically scheduled the cardiologist appointment to immediately follow the echo., so I can get the results right away. (This is actually their normal procedure.) I did have an echo. a few years ago, at the request of my sister's cardiologist, after SHE was diagnosed with HCM. Just as you said, that tech. was quiet as a church mouse. Only my GP was allowed to give me the results. My doctor's office called to arrange an appointment, to give me the results. "Can't you just tell me over the phone?" "No." So, a week later or so, I haul myself all the way downtown, park, and wait to be seen, so he can tell me I don't have HCM. :( In his defense, he did have to tell me about my MVP, which was discovered in that echo. So...
skydnsr, thanks! :-) I am looking forward to my echo. and cardiology consult. Alas, just an hour or so ago, the cardiologist's office called to tell me there will be no technician available on the day of my appointment, and will have to re-schedule. :-( On the plus side, I will have my loop monitor that much longer, and hopefully snag more data. I mean...I don't want a more serious episode to occur, but if it's going to, it'd be great if I'm still wearing my monitor. I haven't had any really bad incidents while wearing it so far; just mild ones.
The symptoms you describe in your first post seem to match perfectly the symptoms of shock. This is usually caused by a sudden drop in blood pressure and lack of oxygen to organs. I remember having an accident once, where a very heavy object fell onto my hand and trapped me. I suddenly felt all the symptoms you described and it was very scary. Luckily, when the object was removed, I recovered, but it took about 20 minutes.
I'm going to go out on a limb here and say that every single symptom you've listed is consistent with ANXIETY and it sounds like you've had an anxiety attack (let's presume all your other results have been normal).
While you may not have felt anxious before your first attack, that doesn't preclude you from having an anxiety attack. And now you've had one, you will likely (and rightly so) fear another one leading to these continued symptoms.
My other thought was how much had you eaten that day? Was it sufficient? A lot of your symptoms also could have been from hypoglycemia. And then the rest after that, pure anxiety and panic.
Just some food for thought. Given normal vitals (when you remember to check), this would be the most logical differential diagnosis. Think horses when you hear hoofbeats, not zebras.
Shock sounds HIGHLY unlikely. There was no blood loss, cardiovascular collapse, infection, etc. Again, I strongly believe this is anxiety. I have seen shock (I am an ICU nurse) and you just don't bounce back from it like that.
oh, and just to back up my differential, when you experience anxiety or panic attacks you tend to hyperventilate. It can cause every single symptom you've listed. When you overbreathe the concentration of carbon dioxide decreases in your blood leading to these symptoms. Google this and/or hyperventilation syndrome and see if it makes sense to you and your situation. Good luck!
I've been fortunate like you to have the availability of vascular, cardiac and digestive tests, and always the tests have either ruled in or out problems. I think I read that you have MVP, and so just everyone who reads this thread. Everyone has a degree of MVP. Probably everyone has goofy heartbeats.
Given your tests, I'd rest easy and listen to ChesterCookie.
I know the symptoms are similar to shock...but it's impossible. I know my posts are very lengthy, but I described how it all began: normal day, normal morning workout, nice big breakfast with the hubby, almost 50 years of nearly perfect health behind me, sitting quietly on the couch, playing solitaire on my iPad about a half hour after breakfast and...BOOM! Feeling as though I'm losing consciousness, heart pounding, eyesight blurry, muscle trembling, cold hands & feet, then chills turning to full body shivering, nausea, and diarrhea. ...No heavy objects involved. :-)
So, that's an avenue for consideration. What might mimic the signs of shock?
Although I did have 2 mild (1-2/10) "episodes" last week, they were the first in 3 weeks, and the last since last week. Mostly, nowadays, I'm suffering from individual symptoms (alone or a few at a time), such as heart pounding (that wakes me from sleep), head "swimming", blurred vision, diarrhea. I mean, just yesterday, I had retty minor symptoms, but they lasted all day, and the two times it got a bit worse, I also had diarrhea. I have low-grade headaches, too, plus lots of random weirdness.
Oh, joy... They pst-poned my echo. & cardiology consult yesterday. Today, I earned the new date is in NOVEMBER!!!
I appreciate all your suggestions, ed34, and I guess I'll wait to check back in until after my cardiology consult. :-)
Thanks for taking the time to try to help, ChesterCookie. :-) I'm going to do my best not to become infuriated by the suggestion I'm imagining some sort of psychosomatic disorder, ;-) No. I'm not magining this problem.
Of course you don't know me, but I'm aproximately the last person on earth to suffer from "anxiety". (Even the term makes me roll my eyes.) I'm the one consoling an injured person and smiling, saying, "You'll be fine. Head wounds just bleed a lot." I annoy pranksters because it is nearly impossible to startle me. (I have the opposite response. I relax when a sudden noise or event occurs. It's a learned response from many years specializing in training difficult horses. Tense-up on an already-fractious horse, and you're done. Stay relaxed, especially when something startles the horse, and you can keep it calm.) I'm no fun when someone is looking for solidarity in worrying about this or that. "Worry," I often say, "is wasted effort. Just figure out what the problem is, come up with a plan of action, then implement it. Worry is counterproductive."
I do yoga almost every day. Even during my sometimes frightening episodes, my heart rate doesn't go above 100. While I describe the sensation if not getting enough oxygen, I also describe my awareness that my breathing is neither rapid nor laboured. Take my resting blood pressure at any given time, and it'll be more like 98/58.
I have a beautiful, nearly stress-free life. I know I'm so blessed that I welcome friends to chastise me if they ever catch me complaining. In short, I don't meet any of the anxiety parameters.
As I was reminding the other person, I spent nearly 50 years in near-perfect health...not an anxious bone in my body. Then, one day, out of the blue, after a normal morning workout, then big breakfast with my spectacular husband, and while quietly playing a game of solitaire on my iPad (I mean...I couldn't have been mre relaxed) about a half hour after breakfast, I had my first episode.
I'll grant you that I have DEVELOPED a level of concern for my well-being SINCE this sudden onset of symptoms, but not to the point of anxiety. Even during the worst of it, I kept our plans to go to our remote, island cottage for several days, with my usual adage, "whatever happens, happens." (My husband really tried to talk me out of it, primarily because of our remote location, should something happen. But I wanted to try to keep living as normal a life as possible.)
Because 4 of the 5 worst episodes in the beginning occurred shortly after meals (but, obviously, not after every meal), I was particularly interested in the glucose part of my CBC. Happily, it was normal. It appears that the proximity to meal time was likely just coincidental, after so many episode-free (albeit not symptom-free) weeks, now.
Soooooo...that's why I'm here. I have some symptoms of several conditions, but not most of those which would match any one thing convincingly or plausibly. It's a puzzle. I'm increasingly less-concerned about the possibility of any non-life-threatening conditions; however, those which suggest TIA/stroke will make me think twice. When my scalp is numb, my eyesight grows blurry, and I get a pain across my occiput or radiating down one side of my face, I wonder about TIA or some other issue relating to blockage, tumor, etc. But doctors have summarily dismissed that, so far. So, I remain hopeful about my ultimate diagnosis/prognosis.
If you have any other suspicions, I'm all ears (or eyes, in this case). :-)
Oh, I should explain the stool analysis, I guess. I don't think anything will come of it, but this is how it went down...
When I saw my new, family doctor for the first time, he did a basic physical exam. At one point, he stopped and asked if my abdomen was always so "grumbly"? I replied that if it was, I wasn't aware of it.
That's why he asked for a stool analysis. I don't have the results of that test, yet. But I doubt something intestinal is the cause of my varied, sometimes quite intense, multi-system symptoms.
Naturally, though, now that he's mentioned it, I'm very aware how much my belly grumbles. :P ...And I do aways have either diarrhea or loose stool with more severe symptoms and with every full-blown episode. (At some point, during an episode, I always have to decide if I'm up, yet, for a run to the loo.)
I can't figure out exactly how diarrhea (or it as a major symptom) could be related to heart pounding, heaviness in my chest, blurry vision/difficulty focusing, the feeling I'm about to lose consciousness or not getting enough oxygen, numb scalp, muscle trembling, chills/shivering, and on and on. I can see how some GI problem could be related to the nausea, diarrhea (obviously), general discomfort, etc.
I don't know if I mentioned this before, but I had the two most intense episodes of diarrhea I've ever had in my life, seemingly out of the blue, in the middle of the night, exactly one week before my first episode. I keep this diarrhea incident as the second entry in my log. The first is the fact that, about a month earlier, my husband and I had really bad cold symptoms, lasting at least 10 days. (It's rare for either of us to get colds at all, much less ones that last more than a few days.) We later discovered there had been a whooping cough outbreak in our area, and our symptoms matched adult whooping cough quite well. We'll never know for sure, though.
In any event, that was in July. I felt perfectly normal until I had the back-to-back bouts of intense diarrhea (unrelated to any known issue, like illness, food poisoning, etc.), in early August. Even the very next morning,
I felt perfectly normal, all the way up 'til a week later, in mid-August, when I experienced my first episode. Even then, I was back to normal by the next day, and for the next five days, until my second episode occurred. Since then, I have had very few symptom-free days, and even fewer days where I feel completely normal again.
So, that's more info. which may or may not have anything to do with what's wrong with me. :-)
FWIW, I'm a mental health professional, and your symptoms don't sound psychosomatic to me. If you were my psychotherapy client, I would be urging you to get physically checked out. I guess anything is possible, and yes, anxiety can mimic virtually any type of physical problem, but there is a "typical" profile of anxiety-based symptoms, and what you are describing does not, in my opinion, fit that particular profile. All due respect to those who think that this situation may be originating from your mental state, but right now, I'm not buying it. If I'm proven wrong in the future, then we can all be happy about that, because anxiety is something that can be dealt with. Anxiety is not dangerous -- just very, very uncomfortable. But for the time being, I would invite you to keep on going through the process of ruling out physical disorders. Actually, from a psychological point of view, it's necessary to go through all the physical work-ups, just to arrive at the conclusion that a person's symptoms "have" to be of psychological origin. Hypochondriasis and the like are diagnoses of exclusion: a physical/medical contribution must be ruled out by means of thorough medical testing. There are no psychological tests that can definitively rule out a physical problem. People who are hypochondriacs and people who have a real physical problem score the same on tests of hypochondriasis. The psych tests can't differentiate between those two situations. So, again, the only way to find out of you have a mental health problem that is causing your symptoms is rule out everything physical. If you want to do something to try to rule out psychological problems, then probably an initial assessment interview with good therapist would be the place to start. A therapist will usually take your life history and observe how you look and act in the session. A bright therapist should be able, after just one or two sessions, to give you some feedback as to likely a psychosomatic explanation is. I would ask directly, just like that: "how likely do you think it is that my physical symptoms are caused by a mental issue?" Understand that nothing is certain until the answer has been arrived at. These are just my thoughts.
Anxiety is an actual medical condition. It is not "in your head" and it is such thinking that continues to plague the field of mental health and give it its stigma (or "rolling your eyes" as you say). Anxiety, because there is virtually no way to PROVE it (ie, no blood test or scan.. it is usually a case of ruling everything else out that makes people come to the diagnosis of anxiety). Anxiety can be disabling because it creates REAL physical symptoms (such as yours.. diarrhea, dizziness, heart beating hard to the point it wakes you up, difficulty focusing, numbing/tingling in random body parts, etc.).
Again.. if all other tests come back normal, I think you should prepare yourself for someone to tell you it's anxiety related.
Just because you live a stree-free life doesn't mean that hormones (are you approaching menopause??) or other facts in your life can't cause anxiety. And YES, people can be anxious and not even realize it. Sometimes, people with idyllic lives are anxious for no obvious reason, ie,idiopathic whereas some people have clear reasons for their anxiety.
My other thought... if you had really bad diarrhea, perhaps your electrolytes were out of whack, which could also have led to some of your symptoms, and obviously now your bloodwork would not reflect that and again everything is going to appear normal.
Sorry, it just rubs me the wrong way when a legit problem such as anxiety is viewed as an "imagined" disease. It is very real and can be idiopathic and you are not IMMUNE to it because you live such a wonderful life. Just saying. And THAT is why you are going to find a lot of doctors, given your extensive testing, are not going to continue probing you if everything keeps coming back normal.
Okay, so you have an ICU nurse thinking that you probably don't have anything seriously physically wrong with you and that there is a good probability that you have anxiety, and you have a mental health professional thinking that you probably don't have anxiety and that you probably do have something physically wrong with you that is causing your symptoms. Go figure. I think what the difference of opinion, from two presumably knowledgable people, tells you is that your situation is not an easy one to figure out. You have your work cut out for you, to run down all the possibilities. Good luck, and let us know how you fare.
I do appreciate the help...from everyone. Thank you.
(I will grant that since "anxiety" is a psychological problem which can manifest itself as physical symptoms, I probably won't be swayed away from the psychosomatic label. And since there are questions, the answers to which tend to suggest anxiety as a likely cause, and with which I have ZERO in common, I doubt I'll ever get to the point of believing my symptoms are the result of stress. I mean, to be fair, I did look at the medical information about anxiety, and literally laughed out loud at nearly every question. - Are you constantly tense, worried, on edge? Ummmm...noooo. :-) Do you frequently worry something bad will happen? Hahaha...no. What?!? :P - My point being, I have NOTHING in common with the typical anxiety sufferer. So, before I imagine that I'm a unique anxiety case, I'll keep looking for the much-more-plausible physical cause.)
On a curious side note, a friend suggested focal seizure. I considered it, but read that most sufferers can't talk or have involuntary movements during episodes. That doesn't describe me. (I'm here in the heart section because doctors are currently thinking "heart".) Ironically, I just did a search for partial seizure, and this is what someone posted in the first question I read:
"I experience light-headedness - a 'fuzzy' feeling in my brain, visual disturbances (hard to focus on either something direct or in my peripheral vision), rapid heartbeat, muscle weakness and sometimes slight shaking." She also describes a continuing "fuzzy" feeling in her head, beyond her "episodes".
I know. I know. It doesn't match exactly. Nothing matches exactly. But still fascinating. There is some commonality there.
I just had two of the "whoosh" sensations (as I call them...where it feels as though I'm about to lose consciousness), immediately preceded by sudden vision impairment (obvious difficulty focusing), about 30 min's apart. So, while I haven't had a full-blown episode since the first two weeks of my problem (it's now been about 7 weeks since they began), I'm still experiencing various symptoms which are completely foreign to me. I was being awakened in the middle of the night with heart pounding, for a while there. I've had a couple of nights, now, where I've awakened to general discomfort and slight leg trembling; no heart pounding. I'm confident enough to drive again....cautiously. ;-)
I'm still searching, as I await the results of a few more tests. On the plus side, I'm having fewer and fewer bad days.
Thanks for that. :-)
I really am open to considering anything plausible. I don't know what's wrong with me...but something is. it would be a lovely miracle if it would all just magically resolve itself. But since that hasn't happened yet, I have to keep looking for an answer, either to treat/prevent or cure.
Of the few tests that've come back so far, the results show I'm normal or better than normal. I've always worked hard to maintain my excellent health. This (being unwell) is new to me. And as I've said before, I almost don't know whether to hope a test comes back normal (thus reassuring me I'm healthy in that way), or abnormal (if it leads to a possible cause for my problem).
As I mentioned above, a curious possibility might be focal seizure. What I forgot to mention is, many sources suggest they're most likely to occur when the individual is particularly relaxed. My episodes (and virtually all my individual symptoms) occurred when I was extremely relaxed.
Still, I'm waiting to do my echo. and cardio consult before I move on to possibly an MRI, EEG, or CT scan.
Several years ago, I had these spells where I would suddenly become nauseatingly dizzy. It would come from out of nowhere. Each time it happened, I would be completely incapacitated for an hour or more. I was unable to stand up or walk. Nothing relieved it -- not sitting down, not lying down, not closing my eyes, not keeping my eyes open. One time it happened when I was out in the back yard, and I hardly was able to make it back into the house. That was the worst one, because I had to try to walk after it hit me. It happened a total of maybe four or five times, all within a span of about two months. And then it never happened again, and I never found out what caused it. I don't know what to say about it, except that I'm glad it stopped. I hope your thing stops, too.
I really don't have the time to sit down and read through all of these posts but a few things come to mind. One, ask to have a King of Hearts Monitor put on; you wear it for 30 days and you press a button when you have symptoms. You may have the gene for HCM which is generally always heriditary and have yet to develop the actual changes in your heart muscle walls. An MRI to be done? What good will that actually do you, other than to give you another bill? The walls are normal size according to the echo, the MRI isn't going to show you an arrhythmia problem, nor will the EKG unless it is happening as the test is being run. What an EKG WILL show you is if you have a possibility for developing an arrhythmia; if you have WPW, SSS, RBBB, LBBB, Long Q-T, those types of things. Get the 30 day monitor put on.