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Dr. Andrew Rynne

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What does total cholesterol level of 180 indicate?

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Dr. Sagar Makode

Cardiologist

Practicing since :2013

Answered : 1717 Questions

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Posted on Thu, 23 Mar 2017 in Hypertension and Heart Disease
Question: I have always had situational hypertension but after the fact it returns to it's normal or slightly low state. A week ago I had a TIA and was hospitalized where every test known to man was performed and the results were that my arties were clear, my carotids were clear, my heart strong and normal, my lungs clear, my weight is normal and my total cholesterol is 180. Yet I was released and still my blood pressure this morning is 175/82 and has been going up and down every since. I am an 82 year old woman being treated for a slightly low thyroid and require nothing else with normal weight and activity. Any ideas???????
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Answered by Dr. Sagar Makode 41 minutes later
Brief Answer:
See the description below please

Detailed Answer:
Hello,

First thing to confirm, was it a TIA only, but not other conditions like just syncope, vasovagal attack etc. So I'd request you to describe the attack. Was it a positional thing ? Occurred post Urination/motion ?

For how long did it persist and what were your exact symptoms ?

Considering it's a TIA, it could be a thrombotic or embolic. For the first possibility, I assume you have underwent angiography of carotid and intracranial vessels, MRI of the brain. If it's normal, then possibility remains is of partial occlusion of the vessel which lead to symptoms and spontaneous dissolution by the body enzymes leading resolution of the symptoms, thats the reason we couldn't find anything on test, and that's the definition of tia.


Secondly, it can be an embolic phenomenon, it's possible that you have a paroxysmal atrial fibrillation, which is usually asymptomatic and present only sometimes, leading to formation of clot in heart and migration into intracranial vessels leading to all above. The EKG will be normal as it is not done during the episode, and episodes are very short lived. So I guess, you also must have underwent Holter monitoring to pick these episodes. Sometimes patients can have symptoms with these episodes like palpitations, fainting or chest discomfort.

So to summarize, you must have underwent angiography, carotid Doppler, MRI with MRS, Holter monitoring.

For blood pressure, you need to be on medicine. You mentioned about fluctuations, lowest bp above 110 systolic is acceptable and highest we should try to keep under 140 systolic. you should be on medicine for controlling blood pressure.

For treatment, aspirin is good choice, you should also be on Statin like Atorvastatin 10 mg bedtime even if lipid profile is normal.

You should also have a healthy lifestyle like avoiding fatty, oily and high calorie diet. Have low salt diet and monitor blood pressure regularly thrice a day for one week then once or twice a week. If BP is persistently more than 140/90 mmhg, then you should be on medicines for it.

Regular exercises like brisk walking, jogging according your capacity at least 30 min a day and 5 days a week. Lots of green leafy vegetables, fruits, fish once or twice a week, avoid red meat. Avoid smoking and alcohol, if any. There shouldn't abdominal fat deposition or obesity.

So hope it helps you and please get back if you have any further doubts.

Best Wishes


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Sagar Makode 19 minutes later
I went to the hospital immediately upon onset of word slurring and slight facial droop. Had all the tests you mentioned plus echogram and ultra sound for my carotids, MRI, CAT scan and heart monitor for 4days. The original symptoms went away within ten minutes Spent 4 days there being constantly monitored without a blip. All test were perfect. Diagnosis was a TIA. No bleeding in brain but showed small spot where TIA occurred. Still don't understand why blood pressure remains elevated. Could my 75m of Armourthyroid daily for my slightly low thyroid be causing this?
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Answered by Dr. Sagar Makode 10 minutes later
Brief Answer:
Follow-up consultation

Detailed Answer:

Yes, it's a TIA and probably thrombotic which was dissolved by the body. Fortunately, it didn't lead to any damage to brain. But all measures should be taken to prevent any repeat TIA or stroke.

This much elevation of BP will not occur with Thyroxine supplements. You can get your TSH level checked to know the status of thyroid. If TSH is not too low then it means this is a adequate dose for you.

Blood pressure is a age related change and it occurs due to hardening of vessel due to aging. Only risk factor in you was hypertension, it was the factor which led thrombosis in a vessel and TIA.

I guess you are not on any medications for it. You should request your doctor for anti-hypertensive medications like Telmisartan 40 mg or Amlodipine 5 mg once a day. If you are already receiving one, then the dose needs to hiked up.

Don't worry about BP and it can be very well controlled with recent drugs but it should be controlled, otherwise it will continue to increase the risk of TIA and stroke. Also, if it crosses say 210 or 220 then may lead to brain hemorrhage. So I think it's the right time to take care of it.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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