BP – Can anyone help me?

[patti]

I am hoping the plethora of brains here can help me. Mom’s blood pressure keeps getting higher and higher at night. Right now she’s 167/60. Only her systolic pressure is affected because they think the left side of her heart is enlarged. I asked the doctor this question but she wouldn’t really answer me. I keep thinking with her pressure rising that mom is a great risk for a heart attack or stroke and I don’t know what to do about it. The doctor said, “well, yeah, that’s a risk.” But that’s it! How concerned do I need to be? Should my husband be spending nights over there in case something happens? Or, does anyone know at what point (how high) the pressure goes before it becomes critical and I should be calling the doctor at night? I told the doctor if she would just tell me I don’t need to worry about it, I’d drop it. But she won’t/didn’t but she didn’t tell me what to do either.

Please, if anyone understands this can you explain to me where mom’s risk is and what we can/should do? We are willing to spend every night over there if we need to. I just don’t know how high it can go before she’ll have a heart attack or stroke. If there’s anything we can do to help prevent that, we want to know.

Thanks

patti

[sugarwhale]

Dear Patti,
I don’t know if I can be of any help, but I’ll sure try. A lot of people take diuretics to get the B.P. down. When prescribed correctly (usually along with potassium) and monitored, this will do the trick. However, even though a person’s B.P. is high at 167/60, I don’t think it’s CRITICAL. Also, the normal person’s B.P. is higher at night. Also, stress and activity can make it higher. My advice (which, I’m sorry to say, is worthless!) is to go to a doctor who will ANSWER YOUR QUESTIONS! This is something that is easily fixed. My mom had the same problem, due to a leaky heart valve.
I can also tell you that a friend of mine had a mini-stroke a few years ago due to high, undetected B.P. But, Patti, her B.P. was well over 300! Also, this had been going on for DECADES.
You need to have a doctor care enough to explain things. I hope I was able somehow to help.
~~~ Janet

[GL]

Not an answer to your queation, Patti, but just in case this could be useful — a fast and simple way to help recognize the signs of a stroke.

THE SCENARIO

During a BBQ a woman stumbles and takes a little fall. When her friends offer to call paramedics, she assures everyone that she is fine and just tripped over a brick because of her new shoes. They get her cleaned up and get her a new plate of food and while she appears a bit shaken up, she goes about enjoying herself the rest of the evening.

Later, her husband calls to say that his wife was taken to the hospital where she passed away. She had suffered a stroke at the BBQ.

RECOGNIZING A STROKE

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke…totally. He said the trick was getting a stroke recognized, diagnosed and getting to the patient within 3 hours.

Now doctors say a bystander can recognize a stroke by asking three simple questions:

1. Ask the individual to SMILE.
2. Ask him or her to RAISE BOTH ARMS.
3. Ask the person to SPEAK A SIMPLE SENTENCE (Coherently) (i.e. . . It is sunny out today)

If he or she has trouble with any of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher.

After discovering that a group of non-medical volunteers could identify facial weakness, arm weakness and speech problems, researchers urged the general public to learn the three questions. They presented their conclusions at the American Stroke Association’s annual meeting last February. Widespread use of this test could result in prompt diagnosis and treatment of the stroke and prevent brain damage.

[patti]

Thank you very much. I printed off the questions and I will keep them in my purse. I don’t trust my memory for what to ask.

Janet, wow! 300 is high. But you made me feel much better. It took me several nights of research (you’d think this would be easy to find) but I findly found a website that said anything over 240/120 is too high. Either both or just one of the numbers. So now I have something to watch for.

Thank you. I feel better and now that I have some concrete numbers to watch for I won’t worry so much about it.

patti

[lindajo]

Patti, You might go to Dr. Andrew Weil’s website and look up Resparate. It is an approved medical device that runs a couple of hundred dollars that teaches the patient to breathe in a specific pattern that has been shown to reduce blood pressure.

It utilizes simply a different pattern of breathing. It is not yet widely used or accepted but whatever benefit it might give it shouldn’t have side effects or interact with other medications. The website is http://www.drweil.com Lindajo

[patti]

Thanks, Linda. I’ll check into it.

[sherrygal]

Patti-I don’t have a real answer but in my dad’s case his bp was low but his heart rate was fluttering around 147-160 after the attack. His bp was low for several weeks. The problem we are having is not being able to receive blood thinners. He is not improving and in my estimation is worse. Thank you for your kind words. I have learned much from you. sherry
——————————–

dad-age 84 CMML currently hospitalized with serious heart attack

[diner]

Patti,
Mom’s doctor added diuretics and potassium to her regular BP pills and they have greatly helped lower her blood pressure. I hope you can get some answers.

Dee

[sugarwhale]

Dear Patti,
Yesterday, just for the heck of it, I asked a doctor (at the clinic where my mom goes) about an adult with B.P. of 167/60. He waved his hands in front of his face as if to say, “Forget it!” B.P. causes problems in two ways: By being TERRIBLY high and by being high over a long period of time, i.e. years. A reading of 167/60 shows an elevated top number, but it isn’t TERRIBLY high. Lots of things can make a person’s B.P. high: a late hour, coffee, stress, strenuous exercise, etc. All of these things are NORMAL. The B.P. goes down when the situation changes. Everyone will have a temporary rise in B.P. if they scale a flight of steps!
True high B.P. can be easily treated. In fact, there’s something your mom (MIL?) can do for herself, without any doctor: reduce sodium intake!
I just wanted you to know that I asked a doctor about that exact B.P. figure; he says it’s no problem!
~~~ Janet

[patti]

Thanks, Janet. That was very kind of you. I have actually felt much better since reading what you folks posted the other day. Also finding the 240/120 on the web helped me to relax a little.

I think in general, it is right not to worry about her pressure at this point. But she does not have high blood pressure normally. This is a result of the left side of her heart being enlarged, according to her doctor. I did talk to my sister (her husband is a doctor and had an 11yr old die from MDS) and he said that blood pressure is only supposed to rise approx. 10pts. on anyone from a reading in the AM to a reading in the PM. Mom’s is jumping more than 50pts by evening. Tonight she was up to 172. He said the fact that’s it’s rising nightly indicated her heart was failing and having difficulty pumping the blood out of her heart to the rest of the body. The right side of her heart appears to be fine and her dystolic pressure is normal (or even a little below). Even with that information, I still feel a little better about where she’s at right now. She is needing blood again so I will talk to the doctor tuesday and show her the week’s stats and she was she thinks about it rising several points every night. At this rate, mom will hit 240 in a very short time!

Thanks again for your help. At least I’ve been able to sleep better.

Patti

[sugarwhale]

Dear Patti,
I think I can even reassure you a bit more about “heart failure.” My father died of it; they diagnosed it and told him it would kill him. It did. BUT, Patti, he lived 48 years after that diagnosis! My mom also has heart failure. The cardiologist said that virtually everyone my mom’s age has it to SOME degree. My mom takes a very mild diuretic and potassium. Her B.P. is excellent, and the cardiologist says she’s doing just great. I asked the cardiologist if my mom’s “heart condition” was something to worry about. She (the doc) said it was absolutely NOTHING to worry about. I think your mom needs treatment, but she’ll be just fine. Left side heart problems are worse than right side, or so I understand. My mom’s is right side. The mild diuretic and potassium is easy to take and causes no ghastly symptoms. My mom will be 89 next time. Her major problem is MDS, not B.P. or heart. She reads, sews, drives, shops, does yard work, etc. Best wishes to your mom and to her daughter.
~~~ Janet

[lynette]

Dear Patty,
I’m sorry to hear that your MIL is not feeling well. From all of your postings, it sounds as if you have taken wonderful care of her.
I am not a physician, but I have many years of experience as a cardiac nurse. Something is wrong w/ your MIL. The question is does she want intervention? Blood pressure does change throughout the day, it also varies with positional body changes–but not to the degree that your MIL is experiencing. Additionally, there is one fact that is very disturbing—the large difference between the systloic and diastolic numbers. We should not see more than 30, anything more usually indicates a problem–it could be anything from a problem w/ arteries to a build up of pressure within the brain. If your MIL wants intervention, now is the time to call a cardiologist. There are non-invasive tests(echocardiogram) that might be helpful.
Regarding heart failure. The treatment and diagnosis of HF has changed a great deal over the past 20 years. We once believed that everyone had Congestive Heart Failure(CHF). Now the thinking is that people have HF, but not everyone has CHF. CHF is the more acute phase meaning that there is fluid in the lungs.
Left HF gives more lung sx. SOB, cough, fluid in the lungs. Right HF has more systemic signs: fluid in the abdomen, bulging neck veins,etc.
Most people will eventually have signs of both.
This must be very difficult for you and your family. These decisions are never easy.
regards,
Lynette

[patti]

Lynette,

That was very helpful. I know there is something very wrong with mom’s heart by these huge changes in her blood pressure over the past several months. I just can’t seem to figure out what to do. Intervention? I don’t think she really wants any because from what we understand there is really nothing they can do about an enlarged left side. Am I wrong? Her NP was supposed to talk to the docs about doing an echocardiogram to see just how large the left side is and if there’s anything else going on. That much we would agree to because it’s not invasive. I think my biggest concern with the whole heart issue is we are afraid she’ll have a heart attack or stroke (she has had some TIA’s)and we won’t be there for his sister. Maybe I want someone with a crystal ball to tell me when we need to be spending the night over there as a precaution. Got a crystal ball???? Right now, she’s taking an 8:00am and 8:00pm BP for me and tells me how she feels in the evening. On evenings she’s having heart/lung discomfort we’re spending the night with her. I guess I see her BP as the only gauge I have for how much her heart is wearing out right now and we are just trying so hard not to leave his sister alone. Mom is still able to fully care for Marie, it’s just times she feels awful and we have to be there. Also, her NP and doc said that it is expected to have her heart wearing out from the long term anemia. Blood transfusions never take her over 11 (and that rarely, she’s usually hits 10) so she’s been anemic for more than 18mos.

Thank you again, Lynette for sharing your expertise. I know in my heart that the left side enlargement is not good. I’m just trying to figure out when I should be there. Any other info you can impart to me is appreciated.

Patti

[lynette]

Patti,
It is very true that the heart can wear out from years of anemia. It attempts to compensate for the lower hemoglobin, and therefore lower levels of oxygen. There are medications that would allow the heart’s workload to be reduced. These meds usually lower BP as well, so they might be helpful for your MIL.
How are her platelets? I don’t want to open pandora’s box, but any chance that her platelets are low enough to cause spontaneous bleeding? I ask only because if there is a cerebral bleed, this increases the pressure in the cranium. One early sign is an increase in systolic BP.. Has her level of orientation changed or do you notice any change is her pupil size? Sorry for yet another worry, but these are possibilites.
My thoughts and prayers are w/ you.
Lynette

[patti]

Lynette,

Don’t be sorry! Thank you for bringing all of this up because it’s stuff we ask the doctor about but never really get more than, “yes, that’s a concern.” That doesn’t help us much. Yes, platelets are a huge issue right now and the big concern is a brain bleed. At last check mom’s plalets were 6000 but her bone marrow is producing nothing now so I bet by the next check this week they’ll be lower. I did not know that brain bleeding would raise the systolic pressure. I’m thinking, bingo. I think you just hit the nail on the head. I will check her pupil size. Yes, her orientation is changing. I’ve been watching carefully. She said this morning she feels fine but I could tell she is not herself. Also, she’s been experiencing some headaches which she never had before. I’m thinking rather than and e-gram I should be requesting maybe a CT scan for bleeding???? What should I ask the doctor for? It’s not that we could do anything about the bleeding, but it would help us to know because then my husband and I would KNOW we need to be spending the nights there. Or, maybe the doctor was right about hospice???? One issue with the platelets is that even at 6K mom is experiencing no external bleeding. While that seems to be good, I believe it’s only because she’s taking large quantities of Vit. K. Because of no symptoms they are not transfusing platelets. Which is fine. But I know that creates issues internally. They did just do a fecal occult test and it was negative. I figure that’s a good sign.

Lynette, you’ve been so helpful with this. Whatever test I should ask the doctor for, please let me know. Like I said, it wouldn’t change our course of treatment but would help us to know what we should be doing in terms of his sister’s care. Thank you.

patti

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