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Old 11-14-03, 09:47 AM   #1
lotek
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Bp different in left and right arm

I know this has nothing to do with training/nutrition/cycling but I'm
stumped as to where to even look for this one (what do I do google
search on?)
My wife came back from Dr. yesterday. Right arm 138/62 (multiple readings)
left arm 92/62 (multiple reads). The left arm reading is more consistant with
her BP in previous readings.
The Dr. wasn't all that impressed with it and kind of blew it off, saying
its not a problem.
So, different readings for left and right arm, whats up with that?
Do we need to find different Md?
Hoping Cbhungry or other medical types might have an answer.

Marty
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Old 11-14-03, 04:20 PM   #2
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subclavian artery stenosis?
might be time for an arteriogram....
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Old 11-14-03, 04:24 PM   #3
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Nah-

Doctors are typically supposed to take readings from the left arm because it's closer to the heart. I wouldnt' worry about it unless the doctor performed some tests and said there's a problem.

The right arm shouldn't have ever been presented for the bp cuff in the first place.

Koffee

P.S. This was told to me by some doctor dude who was showing me how to take a bp reading from the cuff recently. If it's an urban myth, CB can sort me out.
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Old 11-14-03, 04:24 PM   #4
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Are you sure the left arm isnt higher?
There are three arch vessels coming off the aorta, innominate, left common carotid artery and the left subclavian. The only thing I can think of is the right subclavian getting less flow because of the the takeoff of the right common carotid.

Hopefully its not plaque build-up similar to coronary disease but in the subclavian.
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Old 11-14-03, 06:23 PM   #5
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A ten percent variation between arms is no big deal biut this seems slightly excessive. How old is she?


Several studies have established that blood pressure measurements taken from either arm will give consistent results. However, some researchers have reported surprising variation in arm-to-arm blood pressure differences. But these variations were no more than 10- 15% and were in the elderly.

However, your wife shows a much higher gradient, and an underlying condition should be sought.

Congenital conditions in the differential diagnosis include aortic coarctation and thinning of one of the subclavian, axillary, or brachial arteries. Acquired arterial conditions include aortic dissection, atheroma, thrombus, embolus, and extrinsic compression (as might be seen in association with a mass in the upper chest).

Interarm blood pressure difference is a key finding in dissection of the aorta, a life-threatening emergency. However, when considered in light of the characteristics and the low blood pressure readings along with the relative rarity of aortic dissection, the presence of interarm blood pressure differences has no significant positive predictive value in your wife's situation.

Your wife should have a contrast-enhanced CT of the chest to effectively delineate among the possibilities mentioned above. A vascular ultrasound would be helpful as well, but the CT would better show an extrinsic compression.
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Old 11-14-03, 10:45 PM   #6
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Whooo, CB! Dumb it down for me, will ya?



Just kidding. Fascinating. So what that guy told me isn't true, or is it a variation of the truth about always taking bp readings from the left arm?

Koffee
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Old 11-15-03, 08:57 AM   #7
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What CB is saying is there can be reasons for a
difference of this degree and that some of these
reasons are significant and should be checked
out. Contrast CT is a simple, though expensive way
to evaluate this. Best bet is to see a cardiologist or
savvy internist as there has been a significant
sensitization to this problem in the last 10yrs and
some docs are not always up on this. It should
be evaluated, soon but not urgently. Steve
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Old 11-15-03, 09:44 AM   #8
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Originally Posted by Koffee Brown
Whooo, CB! Dumb it down for me, will ya?



Just kidding. Fascinating. So what that guy told me isn't true, or is it a variation of the truth about always taking bp readings from the left arm?

Koffee
right. These studies showed no difference between arms until one got older and then the ten percent variantian showed up.
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Old 11-16-03, 07:38 AM   #9
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The only time I ever heard of something like that is with Aortic aneurysms. Of course she would complain of a tearing feeling through her back if that was the case. This may very well be normal for her though. I've never heard of a doctor taking a BP in both arms before. Was the higher arm always that high each time retested. If the doctor was taking the BP over and over again with out enough time in between, it's going to give false highs. She's probably ok, but if it concerns you that much, I'd go to another doctor and see what they say.
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Old 11-16-03, 08:02 AM   #10
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Sebring, a variation will occur depending on the area of the aorta that is aneurismal or that has a dissection. If there is an aortic root aneurysm both arms will have BP readings consistent with CB's post. It there is a descending aortic aneurysm both arms may follow reading consistent with CB's post. An arch aneurysm......big trouble.

Keep in mind this may not involve the aorta.

Tomorrow I'll ask one of the CT surgeons I work with some specific questions.
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Old 11-16-03, 08:53 AM   #11
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Our baseline is 8% variation.
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Old 11-17-03, 08:17 AM   #12
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Correction:
Left arm was higher reading.
Funny thing is we check B/P regularly and reading for
right arm is consistent with regular results (all taken on
left arm).

Marty
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Old 11-18-03, 08:29 PM   #13
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I need to hijack Lotek's thread... just for a moment since we're on the topic of bp.

I went in for a blood panal and bp reading at a new doctor. I was late and feeling a little stressed from being 30 minutes behind a very tight schedule. When I got there, I barely sat for about 2 minutes before they had me come to the back. I dropped my bag, and while I was standing there, they took my bp. Imagine my shock when for the first time in my life, my bp was over the norm! Normally, it's like 117/76, but today it was 133/82. Of course, that made me more stressed, and then I wondered why it was so high- usually, though, the doctor has me sit quietly at least for a few minutes, then they always take the reading from the left arm. I've never had it taken from the right arm until today, so I just wonder if I should be worried or what.

Anyone ever hear of this?

Koffee
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Old 11-19-03, 03:15 AM   #14
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Quote:
Originally Posted by Koffee Brown
I need to hijack Lotek's thread... just for a moment since we're on the topic of bp.

I went in for a blood panal and bp reading at a new doctor. I was late and feeling a little stressed from being 30 minutes behind a very tight schedule. When I got there, I barely sat for about 2 minutes before they had me come to the back. I dropped my bag, and while I was standing there, they took my bp. Imagine my shock when for the first time in my life, my bp was over the norm! Normally, it's like 117/76, but today it was 133/82. Of course, that made me more stressed, and then I wondered why it was so high- usually, though, the doctor has me sit quietly at least for a few minutes, then they always take the reading from the left arm. I've never had it taken from the right arm until today, so I just wonder if I should be worried or what.

Anyone ever hear of this?

Koffee
Stands to reason it would be higher for all the reasons you mentioned.

Like most tests, they have to be taken with a grain of salt. You are not in a sterile location, devoid of variables. The only way to get accurate data is to repeat the same process every time (which it sounds like your old doc was). Any change to the routine can cause a hiccup in the reading.
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Old 11-19-03, 08:47 AM   #15
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Croak, that could be, but I haven't had a regular doctor. I go to different people all the time, yet I haven't had this problem.

I'm going to my club a little early since they do blood pressure readings. I'll let them do the test for me. I'm not sure how much I trusted the physician's assistant, since she had a hard time taking blood from me (a whole different horrifying story- I have needle sticks all over my cubital fossa on both arms!), and she also did a couple of other small areas. I think when I understood what she was saying and spoke the same medical jargon, it threw her off too, because then she knew I understand gross anatomy and physiology more than the average patient.

I think she actually got a little nervous because of it.

Oh well, I'll get a different answer today.

Koffee
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Old 11-19-03, 08:53 AM   #16
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Quote:
Originally Posted by Koffee Brown
Croak, that could be, but I haven't had a regular doctor. I go to different people all the time, yet I haven't had this problem.

I'm going to my club a little early since they do blood pressure readings. I'll let them do the test for me. I'm not sure how much I trusted the physician's assistant, since she had a hard time taking blood from me (a whole different horrifying story- I have needle sticks all over my cubital fossa on both arms!), and she also did a couple of other small areas. I think when I understood what she was saying and spoke the same medical jargon, it threw her off too, because then she knew I understand gross anatomy and physiology more than the average patient.

I think she actually got a little nervous because of it.

Oh well, I'll get a different answer today.

Koffee
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Old 11-19-03, 10:25 AM   #17
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I must be the worst patient ever!



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Old 11-19-03, 03:34 PM   #18
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koffee, i've had similar variations and they weren't a problem. i remember asking about it at the time, and being told that it wasn't anything to worry about by several people whose opinions i trusted. and the readings were all taken on the left arm.

as far as i know, they were right - nothing ever came of it, and my blood pressure readings returned to normal on subsequent visits. and this was years ago, i have had two sonograms of my heart done since.
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Old 11-19-03, 05:44 PM   #19
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I had my blood pressure taken again today- rode over to my club, blew in like a tornado and was talking like a mile a minute while I sat there and the guy took my reading. It's normal!

Whew, I'm not gonna die today....

Koffee
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