----- Original Message -----
From: "lekhjung thapa" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, August 05, 2003 12:21 AM
Subject: unrecordable diastolic B.P.
> A 66yr/F with intertrochanteric# L-femur had an incidental finding of high
B.P.with systolic of 230mmHg. by palpation.She has normal
vol.R-radial,R-brachial,R-carotid,B/L femoral and B/L Lower Limbs pulses BUT
low vol.L-carotid,L-brachial and L-radial pulses.Her radial arteries feel
cord like.She is known to have HTN.and DM for last 30yrs. on irregular
medicines.
> QUERY:
> 1)What can be the reason for unequal pulse volume?
> 2)what can be the reason for not hearing the korotkoff's sound??
> 3)How to manage hypertension in such cases?
>
>
> DR LEKHJUNG THAPA([log in to unmask])
University college of medical sciences
BHAIRAHAWA, Nepal.
Response 1
Dear Lekhjung, Thanks for this. I have forwarded it to others in various
mailing lists which you can access yourself at jiiscmail.com, sites such as
evidence based health, telemedicine etc. The answer to your last question
would be , an intraarterial line could only let us decide. Its not a big
deal as you might have seen it being used regularly in ours or the western
regional hospital op theatres. See if you can manage to find one with BP
sensors in the hospital you are working at present. Also you should tell us
the BP in both the limbs or is the
left arm so low as to be unrecordable? At the back ground of hypertension
and diabetes I would think of primarily atherosclerotic disease in the
aortic arch, with involvement of left common carotid, left subclavian and
left brachial as well as radial (as you mention it feels cord like too). The
korotkoffs
sounds are only heard when the lumen starts becoming patent after deflation
. In this case atherosclerosis was severe enough to block lumen patency even
after deflation of cuff.
Rakesh Biswas MD, Pokhara, Nepal
|