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Low blood pressure, low pulse, dizzy spells, panic attacks. ECG detected LVH, septal infarct. Can ECG be falsely positive ?

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Cardiologist, Interventional
Practicing since : 1996
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Hi there, I am wondering if there is any significance in having a low 'pulse pressure' . Sometimes my BP readings are 90/75 or so or 95/80, so the range of the difference (pulse pressure) can be anywhere from 15-35 with my readings. I do get momentary dizzy spells when walking. Sometimes I have normal readings (100/70). I have always had lower blood pressure. It used to be about 90/60 but the diastolic seems to have started to increase.
I had a panic attack last month and an ECG reading said LVH, but cannot rule out septal infarct. I had another ECG while not in a panic and it came back normal a couple of days later. I know the ECG can be false, but could it be falsley positive also?
Posted Mon, 30 Apr 2012 in Hypertension and Heart Disease
Follow-up: Low blood pressure, low pulse, dizzy spells, panic attacks. ECG detected LVH, septal infarct. Can ECG be falsely positive ? 2 minutes later
I should specify the dizziness. It is sometimes acute (split second) when sitting or walking. When walking I often feel off-balance, which I understand can be anxiety, but it concerns me a lot that it is related to my Blood Pressure/Heart.
I also have varicose veins in case that matters and am overweight by about 25 pounds.
Answered by Dr. Raja Sekhar Varma 17 hours later

Thank you for posting your query here.

First of all, I would recommend you to confirm your blood pressure by manual measurement using a mercury sphygmomanometer. The electronic devices can give this type of BP readings which are not really accurate. Moreover blood pressure changes according to environmental and postural changes. A persistently low pulse pressure found on multiple readings is needs evaluation.

Having said this, a BP of 90/75 mmHg is perfectly normal and you dont need to worry on that count.

Dizziness can have a lot of reasons other than changes in blood pressure. I advise you to drink adequate amounts of water, increase the salt intake and avoid sudden changes in posture.

If the varicose veins are mild, you could wear compressive stockings which will give you symptomatic relief and prevent venous blood pooling in your legs, which also can lead to dizziness.

Maintaining a normal weight is of prime importance. I would advise you to consult a dietitian and maintain a diet which will help you to lose your extra pounds. Walking half an hour per day is a good and simple exercise with wholesome benefits. Zoloft is sometimes associated with weight gain and you might want to review this with your treating doctor. You should not stop the drug suddenly, however.

If you could upload the two ECGs to this website, I can analyze them and give you a specific answer. The automated electronic report may not always be accurate. At 30 years of age, it is unlikely that you have had a heart attack!

I hope this answers your query. Feel free to contact me for any further clarifications.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Low blood pressure, low pulse, dizzy spells, panic attacks. ECG detected LVH, septal infarct. Can ECG be falsely positive ? 9 hours later
So to confirm the pulse pressure of 15 (the 90/75 reading) is a normal blood pressure. My readings range from 100/70 which is normal to 100/80 (20 pulse pressure). So I do have normal pulse pressures as well as these narrower ones. So long as I have normal pulse pressures it is okay you think? I do not have the ECG as my doctor (GP) has it. I have a 24 hour holter monitor scheduled for Wednesday. If that comes back normal should I be confident that I did not ever have the septal infarct? It will be read by a cardiologist here (although I will not get a chance to XXXXXXX with them). My main concern is the low pulse pressure and I thought the 90/75 was too low? If you think this is okay, then I will try not to worry about this! I think it is averaging a pulse pressure of 20-25-never more than 30 though.

I do wear compression stockings in the hopes of not getting any more varicose veins! Thanks for confirming this suggestion!

I walk for half an hour a day and sometimes feel I have balance issues with this, but manage to do it so it is likely in my head! (or ears or something not heart related) My heart rate comes back down when I get home to about 65 BPM and it is often this. Sometimes it goes up to 85/90 BPM but not usually.

Thanks for any additional advise about the pulse pressure. I get worried as I guess it can signal internal bleeding or heart issues.

Answered by Dr. Raja Sekhar Varma 7 hours later
Thank you for the reply.

As I said earlier, the type of BP apparatus used is important before commenting on the pulse pressure. The electronic, automatic BP monitors often do give this type of results and often, they are misleading and not true BP recordings. You should confirm the accuracy by cross-checking with a manual reading done by an experienced/qualified person using a mercury sphygmomanometer.

Pulse pressure refers to the difference between the systolic BP and the diastolic BP. 30 - 50 mmHg is the recognized normal range. A low systolic pressure and/or a high diastolic pressure can produce a low pulse pressure.

Please note that pulse pressure is only one of the parameters. You could have an extremely low BP with a "normal" pulse pressure, eg: 80/40 mmHg. Conversely, you can have a low pulse pressure with a normal BP eg: 90/75 mmHg.

Low pulse pressure can be present commonly when there is dehydration, low blood volume, cardiogenic/hypovolemic shock and when you have isolated diastolic hypertension.

From what I see from your posts, you do not really have any of the above serious conditions. Dehydration is always possible. I will encourage you to drink adequate amounts of fluids, especially water.

Holter monitoring cannot rule out a septal infarct. It is a 24 hour monitoring of your ECG. It will be possible to identify any significant ST segment changes or any arrhythmias that occur during this period.

The septal infarct pattern can be seen in the ECG sometimes as a normal variant, thick chest wall, problems with lead positioning, a low frequency response characteristic in certain ECG machines, in patients with lung disease, hypertension and LV hyprtrophy, certain conditions like WPW syndrome, etc in addition to true infarcts (damage) to the septal tissue.

At your age, in the absence of any clinical correlation, I do not think septal infarct is likely in your case.

I hope this resolves your queries. Feel free to contact me for any further clarifications.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Low blood pressure, low pulse, dizzy spells, panic attacks. ECG detected LVH, septal infarct. Can ECG be falsely positive ? 2 days later
Thank you. It is an electronic device. I get normal pulse pressure readings on it also however. I have been salting my foods and drinking 2-3 L of water per day.

I did manage a copy of the ECG. I have attached it. It is labelled Aug 31, 2011. I have also attached a normal ECG from April 2011 and one from 2009 for reference.

Can a narrow pulse pressure ever be normal or does it signify the above? Say I take my BP 20 times in the day, I generally get about 6 narrow pulse pressures of under 23...the rest are above that.

What tests should I be getting to look into this do you suggest? Or should I just assume this is normal for me?

Thanks so so so very much!
Answered by Dr. Raja Sekhar Varma 11 hours later

Thank you for uploading the ECGs.

I have seen all the ECGs. The ECG taken in April 2011 is technically excellent. It is also absolutely normal. The so-called "abnormal" ECG has some technical limitations - there is some electronic noise, there is a respiratory variation of the baseline, and there may be some issues with chest lead positioning. Also, the automated report generated by the machine is prone to error, especially when the quality of the recording is imperfect.

I think that the probability of a septal infarct is quite low in your case. However, if you want to be absolutely sure, you can get an echocardiogram done, which will show wall motion abnormalities of the septum, if there was a previous infarct.

A narrow pulse pressure can be normal. Since both the systolic and diastolic values have been within the normal range, isolated narrow pulse pressure by itself is not really significant.

I do not think that you need to check BP so many times in a day! When you do that, you are likely to come up with some erroneous readings, especially when you use an electronic device.

If you are not having any symptoms, you do not need any further tests now.

I hope this answers your query. I wish you all the best for a healthy and productive life.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Low blood pressure, low pulse, dizzy spells, panic attacks. ECG detected LVH, septal infarct. Can ECG be falsely positive ? 1 hour later
As I mentioned before, I did have a normal resting ECG 2 days after the 'abnormal' one that came back normal (and was read by a cardiologist). In this case, and since it is likely i did not have a heart attack as I have no new symptoms, would this be likely adequate to rule out the abnormal ecg?

Thanks so much Dr Varma!
Answered by Dr. Raja Sekhar Varma 11 hours later
Thank you again.

Yes, I think this is adequate to rule out any heart attack.

As I said earlier, if there is any doubt still, an echocardiogram can clinch the diagnosis and effectively rule out a septal infarct.

Thank you, Ms XXXXXXX for the query. I wish you all the best.
With regards,
Dr RS Varma
Above answer was peer-reviewed by
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