Okay, I said there would be a quiz or two.
Here's a REALLY tough one to start out with. (Nursing students, don't feel bad if you don't get this one.)
Patient's vitals (each was taken after being in said position for approximately 5 min.)
Pulse did not change posturally.
1. Supine 55/30
2. Seated 91/62
3. Standing 104/72
4. Supine 60/29
Now I know there is orthostatic hypotension, but what is this?! I've googled, asked doctors, hoped the patient would come back with an answer, but I'm still waiting. Maybe I'll never know. But this is just one of those things that leaves you thinking "What is going on here!" Equipment failure and human error have been ruled out as this pattern is consistent on various automatic and manual cuffs, with at least 5 different medical professionals.
Hint (maybe): Patient presented a month ago in SVT. Put on Lopressor. Patient "felt awful at night" on it, and pulse sitting at rest was in the 60's on a QUARTER of a 25 mg tablet. Normal pulse for patient was in the 90's prior to this. Second episode of SVT, back on Lopressor.
That is just so weird. I can't find ANYTHING that says Lopressor lowers BP more when patient is supine.
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6 comments:
So did you end up finding an answer?
No answer.
That's why I said don't feel bad if you couldn't find it.
2 liters LR helped, and then the patient was transferred. I don't know what was done.
A few of us were just puzzled and couldn't get it out of our head. I guess back to the more routine things, although I tend to have an interest in unusual.
My name is Jason and I have been under the care of an endocrinologist and a neurosurgeon. I am an RN. I have been instructed to monitOr my BP daily and in doing that I did an orthostatic BP. My results were standing- 125/92 supine- 103/71. I do get short of breath with some palpitations when I first lay down. This is just one reading out of many over the last several days but my results were always similar. Like you I can't find an answer but my neurosurgeon mentioned possible autonomic nervous system dysfunction but he doesn't know about my BP yet. My condition is getting worse and any information is greatly appreciated. If I find out anything I will let you know. I just need an answer. Thank You.
My wife has had palpitations and syncope (including black-out) and just today went to her Dr. and a Cardiologist. During her testing at the Cardiologist, her BP was higher standing than laying down. He put her on a mobile cardiac monitor for 30 days. She has a history of migraines and sudden death due to heart arrhythmia in the family. I'm on a hunt for what might be happening / causes and am passing by to let you know you are not alone with this BP oddity.
As a follow-on to my July 14 post, we did a number of BP/heart rate tests using a home BP monitor. From sitting, the longer she stands her heart rate rises rapidly and goes over 100 (sinus tachycardia) and sometimes her BP elevates, sometimes it regulates and her pulse pressure (difference between systolic and diastolic) goes to near zero and she starts to black-out.
Cardiologist think it might be infiltrative cardiomyopathy (not good) which is reducing her heart capacity due to weak in-filling or Postural orthostatic tachycardia syndrome (POTS)
http://en.wikipedia.org/wiki/Postural_orthostatic_tachycardia_syndrome
I think this can have something to do with ME/cfs. I am diagnosed with this, and i have this problem...
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