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have difference in blood pressure between arms. Normal?

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I am 33 years old. My left side blood pressure is 126/83 and my right side 135/88. Should there be such a difference in them? And what could be causing a difference between both sides. When I go to the doctors they only test once side. When I go to the Chiropractor they test both sides?


Posted Sun, 25 Aug 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 38 minutes later
Dear Sir
A difference of blood pressure between two arms to some extent is normal and physiological. The limit defined for this difference is 10 mmHg for systolic (higher value in your BP reading) blood pressure. If the difference is less than 10, it is definitely normal, If it is more than 20, chances of some abnormality are high.
In between 10-20 mmHg, the clinical picture is also taken into account, like presence of pain in arm on exertion or presence of abnormal sounds over blood vessels called "bruits". These patients may also be normal or may be having some underlying disease.
A difference of < 10mmHg, is likely to be physiological. Especially if there are no symptoms and no abnormal findings on examination.The reasons for this difference are mild variations in measurement technique on two side, handedness of individual and normal change over the period of time.
There are various reason for difference more than 20 mmHg which mainly relates to obstruction in blood vessels of one side. These may be non-specific aorto-arteritis/ atypical coarctation of aorta/ atherosclerotic disease/ thromboembolic episode/ subclavian artery blockade etc.
Hope this provides some insight into the issue. Feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: have difference in blood pressure between arms. Normal? 6 hours later
Thank you.

I visited the hospital again tonight.. My pulse went up to 125 while resting, but my BP seemed normal. I asked about the bruits and the other mentioned detail you provided, they tested my troponin levels (Result: 0.0), BP 135/78 once seen, was 118/75 just before I left. The doctor did an ECG (Said it was perfect). He then spent a lot of time probably about 20 to 30 minutes listening to my chest in various spots. Sat me up and listened to my heart in various positions as well. He was still worried about the presents of what he called Tachicardia I think (High Heart Beat at resting), and said I should probably see a Cardiologist just in case, but would have to see my GP to organise it. I was told to discuss what had happened. (Sorry, I had slight chest pain, that then increased, that of which started in the lower left rib join area. then proceeded up my sternal area, mainly on the left. Then spread across into my shoulder, bursa area, and into my thumb and forefinger. I had no pain in between my should and my hand at all, so not running down the arm). Is there anything else that I should be asking my GP in regards to this and similar other pervious un diagnosed episodes. Is there any tests or examinations that would assist in ruling in/out a cardiovascular issue. Just to add to this, it may be off track but is it possible that a nut allergy could cause possible similar symptoms. Why I ask this is that it has only started to occur since I moved to a town thats primary industry is a nut processing plant. I don't work with the products but you can always smell it in the air.
Answered by Dr. Sukhvinder Singh 13 minutes later
Dear Sir
1. A pain which comes on exertion, is behind the breastbone and relives by rest is likely to be anginal or heart related. A pain which is not increasing or provoked by exercise, increases by certain posture, touch or pressing, can be localized to a finger tip, increases by deep breathing is not likely to be anginal. However an acute heart attack / acute pain can come up in a patient without such history of angina on exertion.
2. An episode with normal troponin and ECG is not likely to represent a heart attack. If there are recurrent attacks of chest pain with normal ECGs and troponins, An ECHO to rule out structural heart disease and If normal, then a stress test is normally done under the supervision of a cardiologist.
3. Since the difference in BP in two arms is less than 10 mmHg, it does not require any further work-up. A thorough examination by a cardiologist itself will help in ruling out an abnormal cause for difference in blood pressure.
4. The increase in heart rate to 125, with rhythm being sinus or normal as determined by ECG, We look for inciting or provocative reasons, like any stress/ intake of coffee/ tea/ drugs like anti-cold or anti-asthma/ any pain in body/ any systemic illness/ fever etc.
Hope this helps.
Sukhvinder XXXXXXX
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