high systolic very low diastolic

[ghurty]

Hi,

I am wondering if anybody can tell me what can be the possible cause for an 82 y/o male to have a BP of 142/36 and a hr of 56. The PT stated that he felt perfectly normal. I was O/S for a while, during that time, and on some of those BP readings, the diastolic was about 10 - 15 points higher, but then it went lower again. He also said that his normal BP was about 160/70.

I had this earlier today and I transported w/o medics and I am just wondering what could have caused this? Was is it a true emergency?

Thanks

[vs-eh?]

http://www.wrongdiagnosis.com/sym/wide_pulse_pressure.htm

[HellsBells]

Well you said yourself that he felt perfectly normal, you were on scene for a long time, and transported without the medics, so it sounds like you didn't think it was a true emergency.

What was his reason for calling the ambulance to begin with?

[ghurty]

What was his reason for calling the ambulance to begin with?

As per doctors orders, he takes his own BP once a day using an automatic BP cuff. He noticed the numbers were very different, and he couldn't get in touch with his doctor, so he called.

[Dustdevil]

http://www.wrongdiagnosis.com/sym/wide_pulse_pressure.htm

That leaves out the most common cause:

The inability to take a proper blood pressure reading. :wink:

[whit72]

Gurty wrote:

I am wondering if anybody can tell me what can be the possible cause for an 82 y/o male to have a BP of 142/36 and a hr of 56.

Too many birthdays

Ticker is getting old. Could be 100 things. If he wasn't symptomatic, I wouldn't be too concerned.

Christ everything effects blood pressure, maybe he just rocked a deuce.

I concern my self with, if the patient is symptomatic and his systolic is over 200 or under 100 consistently or any narrowing pulse pressures.

[wrenEMT]

I wouldn't be too worried if the patient wasn't symptomatic. I have had a couple elderly patients that have had a BP of say 100/0 I could still hear a pulse with auscultation during BP. I mentioned it to the ER staff and they weren't too worried. They got BP on their automatic cuff and it was still sitting around 110/0 so I wasn't the only one that got diastolic that is bottomed out...

I also have several dialysis patients that have HTN but after dialysis their BP is sitting at 130/44 or lower.. but they only feel tired because of the effects of dialysis. So it's sometimes normal to have a BP that is off.

[KSEMT122]

I wouldn't be too worried if the patient wasn't symptomatic. I have had a couple elderly patients that have had a BP of say 100/0 I could still hear a pulse with auscultation during BP. I mentioned it to the ER staff and they weren't too worried. They got BP on their automatic cuff and it was still sitting around 110/0 so I wasn't the only one that got diastolic that is bottomed out...

I also have several dialysis patients that have HTN but after dialysis their BP is sitting at 130/44 or lower.. but they only feel tired because of the effects of dialysis. So it's sometimes normal to have a BP that is off.

Well now I am curious. You get B/P's over zero? I would like to know if this is possible. Because hearing it all the way down doesn't make it whatever over zero. You should listen for a change in tones and that is your diastolic. I've had several people who I hear all the way down. It doesn't mean their Diastolic is zero. So my question to the big wigs out there is...Am I missing something here or is a Diastolic over 0 impossible unless your dead.

[captainstandup]

Physiologically impossible to have a diaastolic BP of Zero. The coronary arteries are perfused during diastole. No coronary artery perfusion and the heart checks dies. Given the vitals of 142/36 and a heart rate of 56 I would be curious of a few things.

1)Does anyone know what the patients normal pressure and heart rate is?

2)What medications is the patient on, specifically beta blockers?

3) Is the patient on digoxin?

4) Is the patient on calan or verapamil and another biggie would be Tricyclic antidepressant meds?

Depending on the patients physical build they could be quite dehydrated and if on "rate control" meds unable to speed the heart up. If both systolic and diastolic increaseldby 30 mmhg it it wouldn't result in an abnormal bp per se

[AnthonyM83]

What's the patient's normal pulse rate? Was his pulse regular? Was he put on the monitor? Bradycardia is listed as a cause of widening pulse pressure...if that was the cause, then what was the cause of the bradycardia...