What is the treatment for low diastolic hypotension?
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I have a low blood pressure, normally 100/60, sometimes as low as 80/50 when very fatigued. 47 yo female. A very recent BP was 116/45 w/ multiple symptoms of low blood pressure. Cholesterol is 145 w/o medication. Blood sugar are WNL. I have also had low cardiac myoglobin level. Elevated 8-OHdg. Any comment on the very low diastolic?
Posted Thu, 20 Feb 2014 in General Health
Answered by Dr. Shafi Ullah Khan 3 hours later
Brief Answer: Needs work up and consult Detailed Answer: Good Day Miss XXXX! My name is Dr S Khan and i would like to let you know about your low diastolic hypotension. Miss XXXXXXX diastolic hypotension is the diastolic pressure lower than 65 mmHg. Now your case of diastolic hypotension needs work up. Usually diastolic hypotension is due to decreased cardiac perfusions and there is a structural damage to the walls like cardiomyopathy,aortic regurgitationor malignancy. there might be postural or orthostatic diastolic hypotension responsible for these episodes.Atherosclerosis and arterial stiffness also present with diastolic hypotension.Simple over use of antihypertensive agents and physiologic phenomenas like pregnancy also cause this diastolic decrease.Hormonal issues like addisons also cause that. Usually all ionotrpic agents like Dopamine (Intropin) or Epinephrine or afterload reducers like Inamrinone and milrinone are used to increase the contractility and increase the blood flow.You just mentioned low cardiac myoglobin it means you still doesnt have the MI but it doesnt mean you are not prone to. So my advice seek the cardiologist help.Get your self assessed. A simple echo would be a good start and then some other investigations would let the doctor know what etiology is behind this. its too early to say what that is now.Keep me posted please about your workup and follow ups with your cardiologist Hope this answer finds you in good faith . Kindly let me know if follow up ueries you intend. Other wise please close the discussion and rate the answer as per your experience. Good luck and take some very good care of yourself. Regards Dr. S Khan
Follow-up: What is the treatment for low diastolic hypotension? 11 days later
Thank you for your response. An ECHO was done. I was told it was normal. Report showed mild-moderate tricuspid regurgitation, inferior vena cava dilation, and pulmonary regurgitation, and trace mitral valve regurgitation. Normal L and R ventricular size, normal wall thickness throughout, normal global systolic function with est. ejection fraction at 60-65%. No pericardial effusion. Any comments on the symptoms causing the low blood pressure, chest pain and fatigue? BMI 20.5, active but not high end athlete.
Answered by Dr. Shafi Ullah Khan 13 hours later
Brief Answer: Are you having any symptoms? Detailed Answer: If your echo is normal then the next best step will be to exclude the XXXXXXX disease. what are your serum electrolytes values? if you dont have done it yet.. then get 1) Serum electrolytes 2) Over the morning serum cortisol levels. and reply me with these values
Follow-up: What is the treatment for low diastolic hypotension? 7 hours later
Yes, symptoms are active with excessive fatigue, near black-outs with standing or higher exertion and chest pain. Electrolytes: Na: 143, K: 4.1, Cl: 102 WBC: 5.0 RBC 4.35, Hgb 13.3, Hct 38.8. Serum ferritin: 6. TIBC and iron panel: WNL but not done recently. AM cortisol: 13 done several months ago. HgA1C 5.5, non-fasting blood glucose: 93. DHEA sulfate 90. TSH: 0.78 All labs done 1/21/14 except as noted.
Answered by Dr. Shafi Ullah Khan 14 hours later
Brief Answer: All clear, diet plan with lifestyle modification Detailed Answer: Thank you for getting back to me Miss XXXX! I read your query and all your lab results and i want to inform you that you are very normal in every test provided. Every thing is in normal range and the only issue of black outs and fatigue is the low BMI 20.5. Body mass index needs to be boosted to at least 22. Plus a good dietitian's consult for food regimen and a plan is recommended. I am sure it will resolve as all the mean causes which could possibly be considered as menace for this condition have been ruled out. SO no worries just put up some weight, seek a dietitian help and get a well balanced diet and a healthy lifestyle with a good psychiatric consult to help that angle too. You are very lucky to have all tests clear. I am happy for you. Good vitamin supplements and diet recommendation with a psychiatric consult would be enough to get you out of the issue as you already are out of the woods. you just need to be out of symptoms to which cachexia(low weight) is a reason. Hope this answer finds you in good health. Good luck and take some very good care of yourself. Don't forget to close the discussion. regards Dr S Khan
Follow-up: What is the treatment for low diastolic hypotension? 37 hours later
As a doctor, board certified in clinical nutrition, I am saddened at the least by your conclusion and final thought process. The diagnosed condition as proven by tilt table testing and further lab work shows POTS - Postural Orthostatic Tachycardia Syndrome along with elevated oxidative stress markers with 8-OHdg and lipid peroxides. This is reflective of high level cellular inflammation and DNA damage. It also showed borderline low cortisol and low DHEA. This is early stages of Addison's or adrenal insufficiency. Check it out on PUBMED for low DHEA. You also missed the fact that serum ferritin levels are at a level of 6 (NL: 20-200) which means that there is virtually no iron stored in my body. Between the combinations of these factors, it clearly contributed to altered neurovascular regulation. You also told me that my BMI reflects a state of cachexia. This is far from cachexia and is optimal. Healthy BMIs for women are between 18.5 and 24.9. These are reference ranges thru the NIH. While you are put into a position of offering advice online without seeing the patient and the full picture, your final assessment while showing some compassion is lacking and judgmental in stating that the source of the distress is psychological and poor diet. Just because major factors were ruled out, the subtleties of the situation were ignored and dismissed. While there may be a number of individuals who fit the profile of poor diet and in need of psychotropic support with the poor health of this country, you may want to rethink your thought process as you are working. I hope that you think outside the box and dig a little deeper into helping your patient rather than passing them off. You missed the boat on this one....
Answered by Dr. Shafi Ullah Khan 9 hours later
Brief Answer: Sorry for the inconvenience Detailed Answer: Thank you for the criticism Miss XXXX! I appreciate the effort and response you provided me. But the details and work ups you mentioned were all normal. If you read my first answer my first thought was of addison's, thats why i asked of the work up and all was in normal range. I wonder why would a doctor think or narrate POTS from an online consult when a Simple low weight with all work up in normal range can explain. I am really sorry for your trouble. I will request the XXXXXXX team to refund this query. Had i known it was a test of my skills rather a seek for a diagnosis i would not have been the one to answer. I apologize again for the Mis diagnosis but typing from a thousand miles away with only data to process is what we are provided with is no way equivalent to The sound professional advice a person gets after getting properly examined and worked up for. Hope You see that in the right perspective. Regards S Khan