Pulmonary Oedema incident

[Ayisha]

I didn't catch the DAN seminar - any links handy?

Yes, it's the second seminar at this link and you have to log in to view the seminar, but it's pretty informative: DAN | Online Seminars

 

[Hatul]

Provisional update


So after a battery of tests over the last few months, including:
Ad-hoc blood pressure tests
24 hour blood pressure test
ECG (funny graph thingy - technical term)
ECG (ultrasound flavour - could see heart, valves flapping open close, hear blood flow)
Stress ECG


My cardiologist has said my heart is fine. Nothing wrong at all as far as he can see. My blood pressure isn't as high as we thought (135/80 IIRC - will need to confirm this). No signs of long term high blood pressure such as enlargement or thickening of the heart.


Cheers,
John

About your blood pressure. If I were you I'd get a home BP monitor (Omron makes some good ones) and check your BP a few times a day for several days. Your blood pressure should be 120/80. You don't want to wait to see changes in your heart and blood vessels from hypertension before taking action.

Adam

 

[Ayisha]

Your blood pressure should be 120/80.

You might want to modify that statement. Mine is 104/60 which is low and good. Do you mean not over 120/80?

 

[Bubbletrubble]

Your blood pressure should be 120/80.

You might want to modify that statement. Mine is 104/60 which is low and good. Do you mean not over 120/80?

Ayisha is correct. "Normal" BP is now considered to be systolic BP < 120 mmHg and diastolic BP < 80 mmHg.

Hatul makes an excellent point, though, that InTheDrink's goal BP should be the "normal" range.
InTheDrink stated that his BP is 135/80.

Current hypertension care guidelines (as referenced in JNC 7) would categorize a systolic BP in the 120-139 mmHg range as "prehypertension." Individuals in this category (vs. "normal") have double the chance of developing hypertension later in life.

For prehypertensive patients without diabetes or kidney disease, the recommended approach is lifestyle modification -- weight reduction, decrease in alcohol consumption, DASH eating plan high in potassium and calcium, low-salt diet, regular daily exercise.

FYI, engaging in aerobic physical exercise, e.g., walking, for 30 minutes a day on most days will decrease systolic BP by 4 - 9 mmHg. That's an easy one to do.

 

[TSandM]

120/70 is kind of a "recognized normal" blood pressure. We used to start treating people for a systolic (upper number) over 140, and/or a diastolic (bottom number) higher than 90. But over the years of interest in this topic, evidence has accumulated that those numbers are too high, and we ought to be treating people at lower values. I would certainly like to see a healthy adult with a resting blood pressure less than 130/80 (but I rarely do!).

 

[Hatul]

You might want to modify that statement. Mine is 104/60 which is low and good. Do you mean not over 120/80?

Yes you're right. Some people have lower blood pressure and that's normal and fine for them, as long as it's not a result of medication. Not over 120/80 over the long term is more correct.

 

[Ayisha]

I would certainly like to see a healthy adult with a resting blood pressure less than 130/80 (but I rarely do!).

I find that alarming that patients with slightly high bp are more common than not. The highest mine has ever been was 110/80, but not in years. My bp has consistently been 104/60 lately and I don't take any medication and have never had high bp. Still, I had 4 abnormal ECG's in the last month with "down spikes" or "T's" or something like that. I recently had an Echo and don't know the results yet and will be having a Stress Echo in a month. Hopefully my cardiac health will be ok too.

 

[Hatul]

I find that alarming that patients with slightly high bp are more common than not. The highest mine has ever been was 110/80, but not in years. My bp has consistently been 104/60 lately and I don't take any medication and have never had high bp. Still, I had 4 abnormal ECG's in the last month with "down spikes" or "T's" or something like that. I recently had an Echo and don't know the results yet and will be having a Stress Echo in a month. Hopefully my cardiac health will be ok too.

Unfortunately here in the US primary preventative care is rather poor at least on a population basis. We have lots of people with no medical care until they present with a stroke or kidney failure. Some get very good care and for some none.

 

[TSandM]

There really is no prevention of high blood pressure. The best you can do is to keep your body weight under control, and stay reasonably fit. But hypertension can occur in people with normal body weight who are active, too, and a component is genetic.

Ayisha, blood pressure is not the only determinant of heart disease. Blood lipids, smoking, and genetics also play a role, with the last probably playing the greatest one. I hope all your tests come back clear; there are other reasons for abnormal EKGs than coronary artery disease.

 

[Bubbletrubble]

I would certainly like to see a healthy adult with a resting blood pressure less than 130/80 (but I rarely do!).

I find that alarming that patients with slightly high bp are more common than not.

@Ayisha: You have to consider the circumstances under which TSandM sees her patients. She works in an ER. Patients are coming in for various reasons -- very rarely are they coming in for a regular check-up. Also bear in mind that the ER is often a high stress environment. If you were to take a normal healthy person with a BP of 120/70 and insert them into the ER environment, I think "white coat syndrome" and the hustle and bustle of the nurses/doctors/police officers/EMTs/paramedics/other patients could very easily account for a temporary increase of 10 mmHg or more in BP.

That being said, we are only now beginning to appreciate the significant patient population that exists in the prehypertensive zone. Primary care physicians are becoming more proactive in treating such patients nowadays.

Best of luck with your upcoming stress echo. I suspect you were placed on a Holter monitor and often times that's what it takes to identify abnormal heart rhythms that come and go.