"Low Blood Pressure" means many symptoms & seriousness, but treatment at right time is the savior-P3

Other causes of “Low Blood Pressure”

Ø The reaction of “vasovagal” can be temporary to even to the healthy person, but with the symptoms like fainting, slow heart rate and also low blood pressure. Causes like pain or emotions of fear such as having blood drawn, gastrointestinal upset or starting an intravenous infusion can also typically cause vasovagal reaction. Autonomic or involuntary nervous system can cause vasovagal reactions, with special reference to vagus nerve that releases hormones that widens the blood vessels and slows down the heart rate. In addition to controlling digestive tract functions, vague nerves also sense the digestive systems’ activities. These causes of vasovagal reactions may also happen to some people with the symptoms like straining at vomiting or at bowel movements.

Ø Orthostatic (Postural) hypotension means a sudden drop in blood pressure when squatting, standing up from a sitting position or lying (supine) position. Gravity causes settling of blood in the legs’ veins -- as a person stands up. In this time less blood comes back to the heart to pump to the arteries and veins, this in turn causes low blood pressure. During the drop in blood pressure, our body responds in an automatic way and increases the rate of heart beat. This condition normally narrows down the veins to send back more blood to the heart for all the normal persons. The patients who have postural hypotension cannot have these compensating reflexes which happen to other normal persons. In this condition the affected person will have low blood pressure and the symptoms of low blood pressure will also surface. The problem of Postural hypotension can occur in any person in any age, but elderly persons are the most of the victims, especially those elderly persons who are under diuretics or under medications of high blood pressure.

Postural hypotension’s other causes are adrenal insufficiency, dehydration, prolonged bed rest and certain rare neurological syndromes like Shy-Drager syndrome which is responsible for autonomically causing damages to nerves and diabetes.

In some cases, young healthy people also become the victim of postural hypotension. The blood pressure and heart rate may drop to any one after prolong standing. This may cause often fainting, nausea and dizziness. The affected individuals will get wrong responses from the nervous systems. With this condition, a person’s heart, after prolonged standing, will be directed to slow down. The veins in this condition will dilate, which will result in removal of blood from circulation in the arteries.

Ø Micturition syncope refers to blood pressure drop in a temporary way, in addition to consciousness loss when passing urine. The condition is mostly seen among the elderly patients. The problem is due to hormone release, causing low blood pressure.

Ø Insufficient Adrenal is the result of Addison's disease. The problem can lower down blood pressure. Addison's disease destroys adrenal glands, which are situated at the adjacent to the kidneys. Once the adrenal glands are destroyed, it can no more produce sufficient hormones (with special reference to cortisol).   Cortisol is very important for maintaining normal body functions, such as heart functioning and blood pressure maintaining. If a person is affected by Addison's disease, the person may symptomize like weight loss, fatigue, muscle weakness, sometimes darkening of the skin and low blood pressure.

Ø One more bacteria-borne severe infection is Septicaemia. In this condition bacteria or some type of infectious organisms enter in a person’s blood. The original place of infection is the lungs that cause pneumonia. The other places of infection may be abdomen or bladder due to gallstones or diverticulitis. This follows entry of bacteria into the blood and causing toxin release, which in turn can cause septic shock or profound low blood pressure. The condition is life threatening and in many cases it causes damages to many organs.

Ø Anaphylactic shock or Anaphylaxis is a strong and fatal allergic reaction due to medications like intravenous iodine for some X-ray studies and penicillin or bee or some other insect stings and finally foods like peanuts.

The affected person, in this condition, will experience severe blood pressure drop along with wheezing and hiving as the air-way constrictions. A few of the affected person will have swollen throat, causing breathing difficulties. The cause of the problem is blood-containing blood vessels’ enlargement and also the leakage of water from blood to the tissues.

Low blood pressure diagnosis and evaluation

The suspicions of low blood pressure, even in the healthy persons, are weakness, fainting and dizziness. A few others may experience the severity of symptoms like heart attacks.

The initial measurement of low blood pressure is done in both ways: 1) supine that is lying condition and 2) standing position. Some of the low blood pressure patients may have orthostatic symptoms. In this condition, the heart rate always goes up, but detecting the cause of low blood pressure is the main goal. In some cases the causes are very much visible. The examples are sudden shock after receiving iodine contained X-ray or for trauma due to loss of blood. The other causes can be diagnosed by testing through the following ways:

1) Complete Blood Count (CBC) can detect 1) anemia due to blood loss or 2) Infectious elevated blood cells.

2) Blood electrolyte measurements can reveal about mineral depletion & dehydration, kidney or renal failure or even excess acid in the blood (acidosis).

3) Addison's disease or adrenal insufficiency is diagnosed by measuring Cortisol levels.

4) Urine and blood culture tests are done for diagnosing bladder and septicemia infections.

5) Many radiological studies like abdominal ultrasounds, chest X-rays and (CT or CAT)   computerized tomography scans are done for detecting the presence of pancreatitis, pneumonia, gallstones, heart failure and diverticulitis.

6) Abnormally rapid or slow heartbeats, heart muscle damage due to previous heart attacks or due to decreased blood supply to the muscles of the heart pericarditis, (but not yet caused heart attack), can be diagnosed through EKG (Electrocardiograms).

7) Recordings through Holter monitor is done for diagnosing abnormal heart rhythms’ intermittent episodes. In case of occurrences of intermittent abnormal rhythm, the standard EKG may not reveal the actual problem of abnormal rhythm. For continuously monitoring the heart rhythm, a Holter monitor is the best option for knowing about the heart rhythm of the patient for 24 hours. Holter monitor can (in most of the cases) detect the intermittent episodes of tachycardia or bradycardia.

8) Patient-controlled event recorder is used for recording infrequent episodes of tachycardia or bradycardia, any 24 hour Holter recorder may miss to capture the sporadic episodes. A Patient-controlled event recorder becomes the best alternative in this situation. The device can keep recording the data even up to 4 weeks. The operation of the device is completely in the hands of a patient, who can start or stop the recording as per the symptoms of the low blood pressure or because of abnormality of the heart rhythm. After the recording is done, the doctor can analyse the recording at some later date to identify the abnormal episodes.

9) With a view to examining the motion and structure of the heart, Echocardiograms or ultrasound is the best or perhaps the only option, as on date. Detection of the presence of pericardial fluid due to pericarditis is done by Echocardiograms. The ECG images can reveal about the extent of damage of heart muscle, heart valve’s diseases and tumors of the heart, even in rare cases.

10) ECG examination can detect about the problems in the leg veins while pulmonary embolism or deep vein thrombosis can be detected by the chest’s CT scan.

11) Testing through Tilt-Table can evaluate the patients, who are suspected to be suffering from syncope or postural hypotension. The cause of this type of dysfunction is abnormality in autonomic nerves.

System of Tilt-Table Test

A patient, with an intravenous infusion, has to lie down on the examination table for the Tilt-Table Test. The test is duly monitored along with blood pressure and heart rate outcomes. While the patient is in the lying position, the table is tilted for minimum 15 minutes and maximum up to 45 minutes. Blood pressure and Heart rates are also monitored within a few minutes’ intervals.

The aim of the Tilt-Table test

The aim of this test is attempting to the postural hypotension’s reproduction. In some cases, doctors may intravenously use Adrenalin, Isuprel (epinephrine) for inducing postural hypo-tension.

Low blood pressure’s treatments

o A person has low blood pressure but without any organ damage or other symptoms, does not need any treatment. Anyone with the symptoms of low blood pressure must be under medical supervision. None should have “go-getting’ attitude in any type of physical condition, especially if the condition is really symptomatic. Only the doctors can identify the real cause of the abnormality and the cause will determine the type of treatment. The example may be, if the low blood pressure is due to drug abuse, either the medications have to be stopped or the doses need to be reduced. You must neither stop the medication nor adjust the doses of your own. In every case you will consult your doctor.

o A dehydrated patient is treated with electrolytes or minerals or fluids. If the patient has mild dehydration minus vomiting or nausea, the patient needs electrolytes and oral fluids as the treatment. In case the dehydration is either moderate or severe, only hospitalization or emergency treatment through intravenous fluids and electrolytes can be the available treatment.

o The treatment of blood loss will be according to the causes of blood losses. The options may be either blood transfusion or intravenous fluids. In case the bleeding is severe or it is continuous, it should be treated immediately.

o If the person has got septic shock, the treatment will be the antibiotics or intravenous fluids.

o The example of drug abuse is Bradycardia. The medications can be changed, reduced or even stopped by the doctor. The problem may also cause due to implantable pacemaker for treating heart block or sick sinus syndrome.

o Diuretics or blood pressure medications are changeable, adjustable or even stoppable by the doctor, if the symptoms are of low blood pressure.

o Tachycardia’s nature determines its treatment’s course. Examples are: electrical cardioversion, oral medications or pulmonary vein isolation i.e. catheterization procedure is the options for treating Atrial fibrillation.

o Either an implantable defibrillator or medications can be the treatment of ventricular tachycardia.

o Blood thinners, such as heparin in the initial stage, are used for treating deep vein thrombosis and pulmonary embolism.

o Treating of pericarditis is done by removing pericardial fluids. The procedure is called pericardiocentesis.

o The treatment of postural hypotension is the change of diets, which may include increase of salt and water intake.

o The blood pools in the leg vein may be the cause of increased intakes of caffeinated beverages, which can be treated by compressing the stockings of the leg. The treatment can reduce the pooling of blood in the veins of legs. However, some patients need medications like ProAmatine or midodrine for its treatment.   But the underlying problems with midodrine are increase in blood pressure while in upright position. However, too high blood pressure can be observed while in the supine position. This condition increases the risks of strokes. Some researches from the authentic medical institute in USA have suggested that medications for treating myasthenia gravis i.e. muscle weakness are Mestinon or pyridostigmine. The side effects of these medicines (Mestinon or pyridostigmine) increase blood pressure only in the upright position and not in supine position. Pyridostigmine is used for treating as anticholinesterase medication for the patients in the standing position and has the problem of autonomic nervous system. The side effects of the medicine are increased frequency of bowel movements or minor abdominal cramping.

o If a patient is suffering from postprandial hypotension, he or she has low blood pressure. The occurrence of this problem is mostly seen after the meals. To treat this problem, indomethacin (Indocin) or Ibuprofen (Motrin) will be the best option.

o The treatment of Vasovagal syncope can be done through various types of beta blockers types of drugs. Other selected serotonin reuptake inhibitors like escitalopram oxalate (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), sertraline (Zoloft) and fluvoxamine (Luvox) can also be used for treating the problem. The drugs may also include Inderal LA) and propanolol (Inderal). Dehydration preventive drug like Fludrocortisone (Florinef) can also treat kidneys for retaining water. The alternative to the drug therapy, for some patients, is the pacemaker.

o There is no proof of natural remedies. However, herbs like aniseed, ginger, rosemary, pepper and cinnamon are found to be beneficial in some cases. But never take any herb without consulting your doctor.

o Most noteworthy point is if you intake extra salt in your diet, you are inviting heart failure. The best suggestion is consult your doctor for your salt intake.



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