Question - Would You Have Gone To ER?
 

This morning, at 11 am, a friend was at my house for brunch w/ my wife.

Friend is a 50-ish y/o woman in good health. She started feeling dizzy, tunnel vision, had trouble hearing, had trouble speaking or forming words. After a while it passed.

Wife took friend home. At home friend checked her BP, it was 160/something at HR 60. That is high for her, she's usually like 120/something. Not on BP meds, no history of high BP (I think the BP cuff is her husband's).

During the day, friend checks occasionally. BP keeps going up.

We pick her up at church at 7 pm, she's finished a performance (she's a musician) and we don't want her to drive home alone. She says her BP is now reading so high, her cuff must be broken. I have brought my cuff. It reads 187/97 pulse 60.

She is otherwise feeling fine, no chest pain, dizziness, trouble speaking, nothing. She has a family doc appointment tomorrow.

We call two doctor friends. The GP says no need to go to ER. The pathologist says go to ER.

We take friend to ER. They measure her BP 190/100. I left her there waiting to see the doctor, my wife is with her, I needed to get home and take care of kids.

So I wonder now. Should she have gone to the ER? Or just seen her regular doctor tomorrow?

I'm now reading that brief high BP, by itself, is not cause for alarm. Unless it is really high, like 220/110. Or continues for several days. But she had the weird episode in the morning . . .

She has insurance, this is more me curious about what to do in future.

If they are having neuro symptoms, the speech, auditory and visual disturbances with the high BP, I do not pass go, do not collect $200, go directly to ER. You only get the one brain, best to take care of it.

Knew a guy who had dumped his Harley, got headache, ringing in his ears a couple days later so he called and made an appt with the doc. Went to bed and never woke up, slow epidural bleed. He was early 50's, about Hugh's age I guess.

I would have called 911 when the cognitive problems became apparent. Those symptoms can hint towards life threatening problems - aka stroke. I'd rather risk a POed friend than a dead one!

G

I vote ER.

The symptoms earlier in the day may have been a TIA/RIND. Kind of a mini-stroke. (Or maybe she just swoons in your presence, who knows.) But for her BP to be elevated without reason can be concerning. It's not just the first (systolic) number--it's actually the second (diastolic) number that can be more concerning. That DBP of 100 that you recorded is slightly eyebrow-raising. Again, that puts her at risk for not just a heart attack, but a stroke as well.

I'd hate to think your friend would have waited overnight to see her PCP the next day...and then stroked out sometime in the middle of the night. If she's having issues with vision/speech/balance/etc and has a hypertension, it might be worthwhile for her to be observed overnight or to get a CT scan. Of course, she can call her PCP's office and see if she can talk to him (or the covering partner if he/she is familiar with your friend) to feel out these issues prior to visiting the ER.

ER, no question.

I guess I don't feel so bad.

Been getting very conscious about unnecessary health care - all the times we've talked about it, I suppose.

A good friend, a dancer, dropped dead during a performance a few years ago. Heart. He had been feeling poorly that day. I still think about that.

just getting dizzy freaks me out because I never get dizzy. Dizzy plus tunnel vision would be extra weird, but if I "had trouble hearing, had trouble speaking or forming words"?! Holy carp, I would absolutely be at the hospital or something immediately. I rarely take meds, I don't even like to take aspirin if I don't have to. I don't go to the doctor, but I'm not afraid of them either.

Wow, if i had that sort of episode, I would absolutely be getting thoroughly checked out right away.

ER for sure after what I have gone through.

Tell me about more about the second number would you? Mine is usually at 87-92 during the evening as I get cracking on this forum. I felt dizzy and they found out about a mini stroke 3 years ago. I was 42. they couldn't wee it in the CT scan but found it the next day in the MRI. After a week in the hospital of running test, they can't fine the cause so they sent me home. My BP is usually around 130ish / 83-5 during the day with I am doing stuff.

Sorry for going off topic.

Jeff

Saw a fellow traveller in the middle of a long flight have a low-BP epsisode.
He was laying in the aisle, white as a ghost, and already looked like a corpse.
His wife and child looked on as the stewardesses gave assistance.

Blood pressure and heart-rate regulate the oxygen supply to the body.
When something is out of whack, it's not a time to guess.

Jeff what is your resting BP? When you wake up in morning, say?

132/88-90 after walking up a flight of stairs. If I eat something and get ready then if goes back down to about 127/85 twenty minutes later. the freaking alarm clock usually strike fear in me and I bonce out of bed. I don't know why.

As a reference:
I check my blood pressure periodically, mostly just out of curiousity....my morning readings
116-118/72-75 and 42-50bpm
During the day
119-123/77-80 and 55-62bpm resting

What's interesting is that those diastolic/systolic numbers were notably higher before I started taking zoloft......I let life get to me way too much...

No way you can take a chance like that.

Keep us posted.

Wow! Deja vu all over again.

At that point, had I been giving her a ride, it would have been to admitting in the ER.

Or, if you want another opinion, let's ask Dave.

Best
Les

ER- As the saying goes... "Better safe than sorry". Whats the harm in going? A little watsed time if nothing comes of it. What's the harm in not going? Maybe death.

Sounds a bit like what I had. Go to ER. Sounds like a mini stroke to me.

Definitely the er. Before I went on blood press. meds and low dose aspirin daily, my bp was typically 137 over 95. What the lady reported was way too high plus she was feeling dizzy.

The other post above jumping out of bed in the morning - that is not good. I have heard that u slowly get out bed so as to have better blood circulation in the brain. You risk a stroke otherwise:eek:

Er

Stroke is caused by clots or blockages in the arteries supplying the brain. Blockage leads to oxygen starvation of the tissue and death of those brain tissues.
Jumping out of bed may give rise to dizziness, but that is not stroke.

However, I prefer to get out of bed slowly myself. ;)

Best
Les

ER ............ As others have noted when your not "normal" it is best to seek medical help.

This isn't a case of her having eaten some spicy food which has given her a upset tummy.

"dizzy, tunnel vision, had trouble hearing, had trouble speaking or forming words" All of those together should say "get me to advanced medical help right now" to you.

ER would be the way to go!

But once at the ER mention the issues that caused you to go. When I had my stroke the hospital thought I was a drug overdose and they did not perform a brain scan until much later. My stroke imapcted the Temporal and Frontal lopes. Neither good places to stroke out and have nothing done for 12 hours. If I would have received meds I would have made a full recovery. I was 38 at the time of my stroke.

I stand corrected. I knew there was a reason not to get out of bed quickly. I am just a layperson so tomorrow I will lay in bed all day and not test the head theory.:)

One thing I don't see above is that she should see her regular doctor fairly soon and review this event, together with past medical history. IIRC, she can now get a free physical every year - it is certainly time to do so.

Also, she will want to recollect if the symptoms presented more on one side of the body - it is another clue.

There are may maladies that can cause those symptoms.

Many are serious. Some are REALLY serious.

I would have gone to the ER IMMEDIATELY.

While that may not have been any type of stroke, it is worth knowing that there are (2) general types of stroke: ischemic (a blockage) and hemorrhagic (a bleeder). Neither is anything one should be casual or dismissive about.

What has been described above by others above (an ischemic stroke) is only one type.

For either type, but especially for an ischemic stroke, how quickly treatment is given (like with tPA "clot buster" drugs) means a lot to the patient's level of recovery.

Kind of weird outcome.

Friend's BP declined to high end of her normal range, while waiting in the ER. The ER doctor said friend had a "fainting spell", and sent her home. No scans were done. Some sort of blood work was done. Friend did describe the events and symptoms clearly as I've described them, and the 190/100 BP mentioned was measured by the triage nurse when friend initially arrived at ER.

Today, friend's primary care doctor said only cause he could suggest was the brunch my wife served. Which was, I'm told, scrambled eggs, greek yoghurt, some granola, some blueberries, a veggie sausage, decaf latte. All stuff friend eats normally. No tests or other work are being done.

So, I guess I'm glad nothing is so wrong that the doctors are doing anything, but it seems kind of, I don't know, incomplete.

I'd go back to primary and request scans be done on head to make sure it wasn't a stroke that docs did not catch and start taking baby aspirin daily if no other conditions exist..

Bull Siht. When I went to the ER, the doc said Ihad no symptoms of anything and gave me sea sickness pills. Gave me another dose after an hour. still I was dizzy. The freaking room was spinning a little and was constant. My sister came by and demanded he give me a cat scan. The doc decided against it. finally, they did after my sister screamed at them. She demanded an MRI. The doc refused again. she caller he doctor at her hospital, and they suggested that an mri was necessary. Finally, they admitted me and did it the very next morning. By the afternoon, the doctor told me I had a minor stroke. A very baby one, thankfully. After that I was in there for a week running test and found nothing. Now I freak out with my BF and check it all the time. I check it about a milllion times a day.

Go back . Get ultrasound of neck veins...yeah those. The ones that damn near killed me.

Me? They did. They even stuck a camera down my throat to look in the back of my heart to see if there's a hole there for the clot to go through. thankfully, no hole. That one kick my azz because I was alert in the middle of the afternoon. How are you doing, fully recovered? If I remember, you have no deficit?

I'm good thanks. Still have probs from the breathing tube. I think they hurt my vocal cords or something. Other small stuff, like the tip of my middle finger is numb on my right hand where the little clamp thing was on my finger. It makes it tricky when playing bass because of no sense of touch. The lower side of my face and neck at the site are still numb and I get like electric shocks once in a while too. Little stuff compared to what it could be.

Posted twice for emphasis, apparently. Oops.

Freakin' Aye. That description screams mini stroke. That BP is not anywhere NEAR normal. That's old world thinking. As recently as ten years ago the general consensus was that 150-160 was near normal and was about where you started thinking about getting meds, but that was optional until you got even higher. Current medical evidence proves that anyone in the 130-140 range is high and should be on meds. The increased risk factor of every ten points over 120-130 is phenomenal. My dad died from that old world thinking. He was under the levels your friend reported, had a full blown checkup about two weeks before he died from a massive hemorrhagic stroke caused by high blood pressure. I'm not surprised the GP you asked wasn't concerned; neither was my dad's. Any newer trained doctor will tell you that the equivalent of two 747 crashes worth of people die every DAY from increased blood pressure in these "near normal" ranges. These are preventable deaths. I have been on a mild BP med since I was about 30. It brought be down from about 140 to right in the 120 range consistently. My life expectancy increased a minimum of 20 years from getting on the medicine when I did.

Almost all strokes give warning signs before the big one comes. Dave is a perfect example. The difference between catching it just before or just after it hits it the difference between the bullet hitting you square between the eyes or whizzing by harmlessly.

Your friend cannot know she did not have a stroke without scans. She has to go to her regular doc and pitch a fit until they give them to her. The treatment she received is far too typical. If she has to, she should insist on being seen by a cardiologist. Dollars to donuts she had a mini stroke that cleared so they didn't see any symptoms. At the very least she needs to get on some meds to keep her BP consistently down where it should be.

Your friend needs to go see a cardiologist, soonish.

Actually, a hemoragic (bleeding) stroke is caused by high blood pressure which can spike with a sudden rise from bed. Elvis's stroke was caused by the increase in blood pressure from him straining trying to take a dump. As people get older, they often get prescribed stool softeners just to avoid that sort of incident.

i had no idea elvis died on the crapper. must been a hunka hunka burnin log.

Five feet of impacted poop in his intestines. He should have eaten more fruit and less fried bannana bacon sandwiches.

You pick up a lot of useless information in my job.

I'm not a cardiologist, so an explanation from one (or any internist) will be better than what I can give you.

You're asking about the diastolic number. In a BP reading, there are 2 numbers, the systolic (first) and diastolic (second). The systolic reflects how high the blood pressure gets when the heart contracts and ejects blood into the arterial system. The diastolic (the number you're asking about) reflects what your blood pressure is in between heartbeats.

You don't want either number too high. (Textbook ideal value used to be taught as 120/80. That's changing, too, but let me just use that value as a baseline.) But, in general, having an elevated systolic value is not as harmful as having an elevated diastolic value. Obviously there are caveats to that, depending on other factors. But if I had to choose between a BP of 130/80 or 120/90 (keeping in mind that textbook ideal number), I'd go for the former, as it's supposed to be less dangerous.

It's one thing to have a high blood pressure for bits of time, such as when the heart contracts. Supposedly a high systolic number reflects less elasticity in the aorta and blood vessels. But it's supposedly worse for your body to have a high diastolic pressure, as that represents what your organs face even when everything is "resting" (when the heart isn't contracting). Continuous high pressure is not good. It can stress/damage organs, which face the brunt of the increased pressure at all times.

You know what Elvis' last seven words were?

Baby, it feels like concrete comin' out.

alternatively

Baby, I'm goin' to the readin' room

thank you, don't forget to tip your waitress