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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is risk involved in systolic and diastolic difference of 20 points

60 yr old woman, dying of pancreatic cancer. Given 1/2 normal dose anabolic steroid to help reduce abdominal and leg/foot edema. Within 12 hours, heart rate up, difficulty breathing, BP low, and was told that IF the distance between systolic and diastolic gets less than 20 points, she needs to call for help. Can you explain WHY that is a risk, what it means? Also, wouldn't you expect BP to be higher with a steroid?? thank you
Thu, 28 Jan 2016
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Pulmonologist 's  Response
Thanks for your question on Health Care Magic.
I can understand your concern.
Yes, you are right about rise in blood pressure after steroid injection.
But it is not true for all patients.
The woman in question might be having heart failure. Heart failure can cause breathlessness, low systolic pressure (hypotension) and edema feet.
In this, steroids won't help. Diuretic and other cardiac supportive drugs are needed.
In heart failure, systolic pressure decreases fast then diastolic pressure. This is due to poor force of contraction by failing heart.
So difference between systolic and diastolic pressures come down to less than 20.
And when this occurs, patient needs urgent treatment in the form of inotropic drugs. These drugs will increase the force of contraction and thus increase the systolic pressure.
So immediately take this woman to hospital otherwise she may succumb any time.
Hope I have solved your query. I will be happy to help you further. Wishing her good health. Thanks.
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