Causes of Blood conditions
Causes of Blood conditions (Diseases Database):
The follow list shows some of the possible medical causes of Blood conditions
that are listed by the Diseases Database:
Source: Diseases Database
Blood conditions Causes: Book Excerpts
Blood conditions as a symptom:
Conditions listing Blood conditions
as a symptom may also be potential underlying causes of Blood conditions.
Our database lists the following as having
Blood conditions as a symptom of that condition:
Medications or substances causing Blood conditions:
The following drugs, medications, substances or toxins are some of the possible
causes of Blood conditions as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Fansidar
- Thiosulfil Forte
- Gantanol
- Azulfidine
- Gantrisin
- more drugs...»
See full list of 12
medications causing Blood conditions
Drug interactions causing Blood conditions:
When combined, certain drugs, medications, substances or toxins may react
causing Blood conditions as a symptom.
The list below is incomplete and various other drugs or substances may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Pyrimethamine and anticancer drug interaction - Serious blood disorders
- Pyrimethamine and antirheumatic drug interaction - Serious blood disorders
- Pyrimethamine and phenylbutazone interaction - Serious blood disorders
- Pyrimethamine and sulphasalazine interaction - Serious blood disorders
- Pyrimethamine and co-trimoxazole interaction - Serious blood disorders
- more interactions...»
See full list of 6
drug interactions causing Blood conditions
Medical news summaries relating to Blood conditions:
The following medical news items are relevant to causes of Blood conditions:
Related information on causes of Blood conditions:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Blood conditions may be found in:
Causes of Blood conditions: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Blood conditions.
Diarrhea – Chronic, No Blood or Weight Loss:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Osmotic: Presence of nonabsorbable solute, pH <5, volume <200 mL/day, normal electrolytes, stops with fasting
-
Secretory: Mostly due to toxins, pH >6, volume >200 mL/day, no response to fasting, stool Na >70 mEq/L, negative reducing substances
-
Toddler's diarrhea: Chronic nonspecific diarrhea, onset 3 months to 3 years of age, average 4–6 stools daily, due to excessive juice intake or low-fat diet
-
Excessive intake of nonabsorbable solutes (lactulose, sorbitol, magnesium hydroxide)
-
Congenital lactose deficiency: Very rare in infancy, but may occur in extremely premature infants; adult-onset type of hypolactasia may be seen in older children (over age 5), autosomal recessive, 15% white adults, 85% of black adults, 90% of Asian adults
-
Secondary lactase deficiency: Follows a viral gastroenteritis, most commonly rotavirus, may persist for months
-
Fructose intolerance
-
Sucrase-isomaltase deficiency: Autosomal recessive, found in 0.2% of North Americans, symptoms commence on starting sucrose or glucose polymer-containing foods
-
Glucose-galactose malabsorption: Rare, autosomal recessive disorder
-
Infections
–Giardiasis (most common infectious cause of
chronic diarrhea in toddlers)
–Cryptosporidium
–Microsporidium
-
Irritable bowel syndrome (IBS)
–Abnormality of intestinal motility and pain perception with no organic basis
–Abdominal pain associated with intermittent diarrhea or constipation
-
Bacterial overgrowth: Enteric bacteria colonizes the upper small intestine
-
Trehelase deficiency (trehelose is the sugar found in mushrooms)
-
Zinc deficiency
–Acrodermatitis enteropathica is typical rash
-
Low-fat diet
'>>
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Blood pressure increase [Hypertension]:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Anemia. Accompanying elevated systolic pressure in anemia are pulsations in the capillary beds, bounding pulse, tachycardia, systolic ejection murmur, pale mucous membranes and, in patients with sickle cell anemia, ventricular gallop and crackles.
❑ Aortic aneurysm (dissecting). Initially, this life-threatening disorder causes a sudden rise in systolic pressure (which may be the precipitating event), but no change in diastolic pressure. However, this increase is brief. The body's ability to compensate fails, resulting in hypotension.
Other signs and symptoms vary, depending on the type of aortic aneurysm. An abdominal aneurysm may cause persistent abdominal and back pain, weakness, sweating, tachycardia, dyspnea, a pulsating abdominal mass, restlessness, confusion, and cool, clammy skin. A thoracic aneurysm may cause a ripping or tearing sensation in the chest, which may radiate to the neck, shoulders, lower back, or abdomen; pallor; syncope; blindness; loss of consciousness; sweating; dyspnea; tachycardia; cyanosis; leg weakness; murmur; and absent radial and femoral pulses.
❑ Atherosclerosis. With atherosclerosis, systolic pressure rises while diastolic pressure commonly remains normal or slightly elevated. The patient may show no other signs, or he may have a weak pulse, flushed skin, tachycardia, angina, and claudication.
❑ Cushing's syndrome. Twice as common in females as in males, Cushing's syndrome causes elevated blood pressure and widened pulse pressure as well as truncal obesity, moon face, and other cushingoid signs. It's usually caused by corticosteroid use.
❑ Hypertension. Essential hypertension develops insidiously and is characterized by a gradual increase in blood pressure from decade to decade. Except for this high blood pressure, the patient may be asymptomatic or (rarely) may complain of suboccipital headache, light-headedness, tinnitus, and fatigue.
With malignant hypertension, diastolic pressure abruptly rises above 120 mm Hg, and systolic pressure may exceed 200 mm Hg. Typically, the patient has pulmonary edema marked by jugular vein distention, dyspnea, tachypnea, tachycardia, and coughing of pink, frothy sputum. Other characteristic signs and symptoms include severe headache, confusion, blurred vision, tinnitus, epistaxis, muscle twitching, chest pain, nausea, and vomiting.
❑ Increased intracranial pressure (ICP). Increased ICP causes an increased respiratory rate initially, followed by increased systolic pressure and widened pulse pressure. Increased ICP affects the heart rate last, causing bradycardia (Cushing's reflex). Associated signs and symptoms include headache, projectile vomiting, a decreased level of consciousness, and fixed or dilated pupils.
❑ Myocardial infarction (MI). MI is a life-threatening disorder that may cause high or low blood pressure. Common findings include crushing chest pain that may radiate to the jaw, shoulder, arm, or epigastrium. Other findings include dyspnea, anxiety, nausea, vomiting, weakness, diaphoresis, atrial gallop, and murmurs.
❑ Pheochromocytoma. Paroxysmal or sustained elevated blood pressure characterizes pheochromocytoma and may be accompanied by orthostatic hypotension. Associated signs and symptoms include anxiety, diaphoresis, palpitations, tremors, pallor, nausea, weight loss, and headache.
❑ Polycystic kidney disease. Elevated blood pressure is typically preceded by flank pain. Other signs and symptoms include enlarged kidneys; an enlarged, tender liver; and intermittent gross hematuria.
❑ Preeclampsia and eclampsia. Potentially life-threatening to the mother and fetus, preeclampsia and eclampsia characteristically increase blood pressure. They're defined as a reading of 140/90 mm Hg or more in the first trimester, a reading of 130/80 mm Hg or more in the second or third trimester, an increase of 30 mm Hg above the patient's baseline systolic pressure, or an increase of 15 mm Hg above the patient's baseline diastolic pressure. Accompanying elevated blood pressure are generalized edema, sudden weight gain of 3 lb (1.4 kg) or more per week during the second or third trimester, severe frontal headache, blurred or double vision, decreased urine output, proteinuria, midabdominal pain, neuromuscular irritability, nausea, and possibly seizures (eclampsia).
❑ Renovascular stenosis. Renovascular stenosis produces abruptly elevated systolic and diastolic pressures. Other characteristic signs and symptoms include bruits over the upper abdomen or in the costovertebral angles, hematuria, and acute flank pain.
❑ Thyrotoxicosis. Accompanying the elevated systolic pressure associated with thyrotoxicosis, a potentially life-threatening disorder, are widened pulse pressure, tachycardia, bounding pulse, pulsations in the capillary nail beds, palpitations, weight loss, exophthalmos, an enlarged thyroid gland, weakness, diarrhea, a fever over 100° F (37.8° C), and warm, moist skin. The patient may appear nervous and emotionally unstable, displaying occasional outbursts or even psychotic behavior. Heat intolerance, exertional dyspnea and, in females, decreased or absent menses may also occur.
Other causes
❑ Drugs. Central nervous system stimulants (such as amphetamines), sympathomimetics, corticosteroids, nonsteroidal anti-inflammatory drugs, hormonal contraceptives, monoamine oxidase inhibitors, and over-the-counter cold remedies can increase blood pressure, as can cocaine abuse.
HERB ALERT:Ginseng and licorice may cause high blood pressure or an irregular heartbeat. St. John's wort can also raise blood pressure, especially when taken with substances that antagonize hypericin, such as amphetamines, cold and hay fever medications, nasal decongestants, pickled foods, beer, coffee, wine, and chocolate.
❑ Treatments. Kidney dialysis and transplantation cause transient elevated blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Blood pressure decrease [Hypotension]:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Acute adrenal insufficiency. Orthostatic hypotension is characteristic with acute adrenal insufficiency, accompanied by fatigue, weakness, nausea, vomiting, abdominal discomfort, weight loss, fever, and tachycardia. The patient may also have hyperpigmentation of fingers, nails, nipples, scars, and body folds; pale, cool, clammy skin; restlessness; decreased urine output; tachypnea; and coma.
❑ Alcohol toxicity. Low blood pressure occurs infrequently; more commonly, alcohol toxicity produces distinct alcohol breath odor, tachycardia, bradypnea, hypothermia, a decreased LOC, seizures, a staggering gait, nausea, vomiting, diuresis, and slow, stertorous breathing.
❑ Anaphylactic shock. Following exposure to an allergen, such as penicillin or insect venom, a dramatic fall in blood pressure and narrowed pulse pressure signal anaphylactic reaction. Initially, anaphylactic shock causes anxiety, restlessness, a feeling of doom, intense itching (especially of the hands and feet), and pounding headache. Later, it may also produce weakness, sweating, nasal congestion, coughing, difficulty breathing, nausea, abdominal cramps, involuntary defecation, seizures, flushing, change or loss of voice due to laryngeal edema, urinary incontinence, and tachycardia.
❑ Anthrax (inhalation). Anthrax is an acute infectious disease that's caused by the gram-positive, spore-forming bacterium Bacillus anthracis. Although the disease most commonly occurs in wild and domestic grazing animals, such as cattle, sheep, and goats, the spores can live in the soil for many years. The disease can occur in humans exposed to infected animals, tissue from infected animals, or biological warfare. Most natural cases occur in agricultural regions worldwide. Anthrax may occur in the cutaneous, inhalation, or GI form.
Inhalation anthrax is caused by inhalation of aerosolized spores. Initial signs and symptoms are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial signs and symptoms. The second stage develops abruptly with rapid deterioration marked by fever, dyspnea, stridor, and hypotension, generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.
❑ Cardiac arrhythmias. With an arrhythmia, blood pressure may fluctuate between normal and low readings. Dizziness, chest pain, difficulty breathing, light-headedness, weakness, fatigue, and palpitations may also occur. Auscultation typically reveals an irregular rhythm and a pulse rate greater than 100 beats/minute or less than 60 beats/minute.
❑ Cardiac contusion. With cardiac contusion, low blood pressure occurs along with tachycardia and, at times, anginal pain and dyspnea.
❑ Cardiac tamponade. An accentuated fall in systolic pressure (more than 10 mm Hg) during inspiration, known as paradoxical pulse, is characteristic in patients with cardiac tamponade. This disorder also causes restlessness, cyanosis, tachycardia, jugular vein distention, muffled heart sounds, dyspnea, and Kussmaul's sign (increased venous distention with inspiration).
❑ Cardiogenic shock. A fall in systolic pressure to less than 80 mm Hg or to 30 mm Hg less than the patient's baseline because of decreased cardiac contractility is characteristic in patients with cardiogenic shock. Accompanying low blood pressure are tachycardia, narrowed pulse pressure, diminished Korotkoff sounds, peripheral cyanosis, and pale, cool, clammy skin. Cardiogenic shock also causes restlessness and anxiety, which may progress to disorientation and confusion. Associated signs and symptoms include angina, dyspnea, jugular vein distention, oliguria, ventricular gallop, tachypnea, and a weak, rapid pulse.
❑ Cholera. This acute infection, caused by the bacterium Vibrio cholerae, may be mild with uncomplicated diarrhea or severe and life-threatening. Cholera is spread by ingesting contaminated water or food, especially shellfish. Signs include abrupt watery diarrhea and vomiting. Severe fluid and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.
❑ Diabetic ketoacidosis. Hypovolemia triggered by osmotic diuresis in hyperglycemia is responsible for the low blood pressure associated with diabetic ketoacidosis, which is usually present in patients with type 1 diabetes mellitus. It also commonly produces polydipsia, polyuria, polyphagia, dehydration, weight loss, abdominal pain, nausea, vomiting, breath with fruity odor, Kussmaul's respirations, tachycardia, seizures, confusion, and stupor that may progress to coma.
❑ Heart failure. With heart failure, blood pressure may fluctuate between normal and low readings. However, a precipitous drop in blood pressure may signal cardiogenic shock. Other signs and symptoms of heart failure include exertional dyspnea, dyspnea of abrupt or gradual onset, paroxysmal nocturnal dyspnea or difficulty breathing in the supine position (orthopnea), fatigue, weight gain, pallor or cyanosis, sweating, and anxiety. Auscultation reveals ventricular gallop, tachycardia, bilateral crackles, and tachypnea. Dependent edema, jugular vein distention, increased capillary refill time, and hepatomegaly may also occur.
❑ Hyperosmolar hyperglycemic nonketotic syndrome (HHNS). HHNS, which is common in the patient with type 2 diabetes mellitus, decreases blood pressure — at times dramatically — if he loses significant fluid from diuresis due to severe hyperglycemia and hyperosmolarity. It also produces dry mouth, poor skin turgor, tachycardia, confusion progressing to coma and, occasionally, generalized tonic-clonic seizure.
❑ Hypovolemic shock. A fall in systolic pressure to less than 80 mm Hg or 30 mm Hg less than the patient's baseline, secondary to acute blood loss or dehydration, is characteristic in hypovolemic shock. Accompanying it are diminished Korotkoff sounds, a narrowed pulse pressure, and a rapid, weak, and irregular pulse. Peripheral vasoconstriction causes cyanosis of the extremities and pale, cool, clammy skin. Other signs and symptoms include oliguria, confusion, disorientation, restlessness, and anxiety.
❑ Hypoxemia. Initially, blood pressure may be normal or slightly elevated, but as hypoxemia becomes more pronounced, blood pressure drops. The patient may also display tachycardia, tachypnea, dyspnea, and confusion and may progress from stupor to coma.
❑ Myocardial infarction (MI). With MI, a life-threatening disorder, blood pressure may be low or high. However, a precipitous drop in blood pressure may signal cardiogenic shock. Associated signs and symptoms include chest pain that may radiate to the jaw, shoulder, arm, or epigastrium; dyspnea; anxiety; nausea or vomiting; sweating; and cool, pale, or cyanotic skin. Auscultation may reveal an atrial gallop, a murmur and, occasionally, an irregular pulse.
❑ Neurogenic shock. The result of sympathetic denervation due to cervical injury or anesthesia, neurogenic shock produces low blood pressure and bradycardia. However, the patient's skin remains warm and dry because of cutaneous vasodilation and sweat gland denervation. Depending on the cause of shock, there may also be motor weakness of the limbs or diaphragm.
❑ Pulmonary embolism. Pulmonary embolism causes sudden, sharp chest pain and dyspnea accompanied by a cough and, occasionally, a low-grade fever. Low blood pressure occurs with a narrowed pulse pressure and diminished Korotkoff sounds. Associated signs include tachycardia, tachypnea, a paradoxical pulse, jugular vein distention, and hemoptysis.
❑ Septicshock. Initially, septic shock produces fever and chills. Low blood pressure, tachycardia, and tachypnea may also develop early, but the patient's skin remains warm. Later, low blood pressure becomes increasingly severe — less than 80 mm Hg or 30 mm Hg less than the patient's baseline — and is accompanied by narrowed pulse pressure. Other late signs and symptoms include pale skin, cyanotic extremities, apprehension, thirst, oliguria, and coma.
❑ Vasovagal syncope.Vasovagal syncope is the transient loss or near-loss of consciousness that's characterized by low blood pressure, pallor, cold sweats, nausea, palpitations or slowed heart rate, and weakness following stressful, painful, or claustrophobic experiences.
Other causes
❑ Diagnostic tests.Diagnostic tests include the gastric acid stimulation test using histamine and X-ray studies using contrast media. The latter may trigger an allergic reaction, which causes low blood pressure.
❑ Drugs. Calcium channel blockers, diuretics, vasodilators, alpha- and beta-adrenergic blockers, general anesthetics, opioid analgesics, monoamine oxidase inhibitors, anxiolytics (such as benzodiazepines), tranquilizers, and most I.V. antiarrhythmics (especially bretylium tosylate) can cause low blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Acute leukemia:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Research on predisposing factors isn't conclusive but points to some combination of viruses (viral remnants have been found in leukemic cells), genetic and immunologic factors, and exposure to radiation and certain chemicals. (See Predisposing factors to acute leukemia.)
Pathogenesis isn't clearly understood, but immature, nonfunctioning WBCs appear to accumulate first in the tissue where they originate (lymphocytes in lymph tissue, granulocytes in bone marrow). These immature WBCs then spill into the bloodstream and from there infiltrate other tissues, eventually causing organ malfunction because of encroachment or hemorrhage.
Acute leukemia is more common in males than in females, in whites (especially people of Jewish descent), in children (between ages 2 and 5; 80% of all leukemias in this age-group are ALL), and in people who live in urban and industrialized areas. Acute leukemia accounts for 20% of all adult leukemias. Among children, however, it's the most common form of cancer. Incidence is 6 out of every 100,000 people.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Blood transfusion reaction:
Causes
(Professional Guide to Diseases (Eighth Edition))
Hemolytic reactions follow transfusion of mismatched blood. Transfusion of serologically incompatible blood triggers the most serious reaction, marked by intravascular agglutination of red blood cells (RBCs). The recipient’s antibodies (immunoglobulin [Ig] G or IgM) attach to the donated RBCs, leading to widespread clumping and destruction of the recipient’s RBCs and, possibly, the development of disseminated intravascular coagulation (DIC) and other serious effects.
Transfusion of Rh-incompatible blood triggers a less serious reaction within several days to 2 weeks. Rh reactions are most common in females sensitized to RBC antigens by prior pregnancy or by unknown factors (such as bacterial or viral infection) and in people who have received more than five transfusions. (See Understanding the Rh system.)
Allergic reactions are fairly common but only occasionally serious. In this type of reaction, transfused soluble antigens react with surface IgE molecules on mast cells and basophils, causing degranulation and release of allergic mediators. Antibodies against IgA in an IgA-deficient recipient can also trigger a severe allergic reaction (anaphylaxis).
Febrile nonhemolytic reactions, the most common type of reaction, apparently develop when cytotoxic or agglutinating antibodies in the recipient’s plasma attack antigens on transfused lymphocytes, granulocytes, or plasma cells.
Although fairly uncommon, bacterial contamination of donor blood can occur during donor phlebotomy. Offending organisms are usually gram-negative, especially Pseudomonas species, Citrobacter freundii, and Escherichia coli.
Contamination of donor blood with viruses, such as hepatitis, cytomegalovirus, and malaria, is also possible.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Chronic lymphocytic leukemia:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Although the cause of CLL is unknown, researchers suspect hereditary factors (higher incidence has been recorded within families), still-undefined chromosome abnormalities, and certain immunologic defects (such as ataxia-telangiectasia or acquired agammaglobulinemia). The disease doesn't seem to be associated with radiation exposure, carcinogenic chemicals, or viruses.
Approximately 2 out of every 100,000 people develop CLL annually, with 90% of cases found in people who are older than age 50. Many cases go undetected by routine blood tests in people who are asymptomatic. The disease is common in Jewish people of Russian or Eastern European descent, and is uncommon in Asia.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Blood pressure increase [Hypertension]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Aldosteronism (primary)
In aldosteronism, elevated diastolic pressure may be accompanied by orthostatic hypotension. Other findings include constipation, muscle weakness, polyuria, polydipsia, and personality changes.
Anemia
Accompanying elevated systolic pressure in anemia are pulsations in the capillary beds, bounding pulse, tachycardia, systolic ejection murmur, pale mucous membranes and, in patients with sickle cell anemia, ventricular gallop and crackles.
Aortic aneurysm (dissecting)
Initially, aortic aneurysm—a life-threatening disorder—causes a sudden rise in systolic pressure (which may be the precipitating event), but no change in diastolic pressure. However, this increase is brief. The body’s ability to compensate fails, resulting in hypotension.
Other signs and symptoms vary, depending on the type of aortic aneurysm. An abdominal aneurysm may cause persistent abdominal and back pain, weakness, sweating, tachycardia, dyspnea, a pulsating abdominal mass, restlessness, confusion, and cool, clammy skin. A thoracic aneurysm may cause a ripping or tearing sensation in the chest, which may radiate to the neck, shoulders, lower back, or abdomen; pallor; syncope; blindness; loss of consciousness; sweating; dyspnea; tachycardia; cyanosis; leg weakness; murmur; and absent radial and femoral pulses.
Atherosclerosis
In atherosclerosis, systolic pressure rises while diastolic pressure commonly remains normal or slightly elevated. The patient may show no other signs, or he may have a weak pulse, flushed skin, tachycardia, angina, and claudication.
Cushing’s syndrome
Twice as common in females as in males, Cushing’s syndrome causes elevated blood pressure and widened pulse pressure, as well as truncal obesity, moon face, and other cushingoid signs. It’s usually caused by corticosteroid use.
Hypertension
Essential hypertension develops insidiously and is characterized by a gradual increase in blood pressure from decade to decade. Except for this high blood pressure, the patient may be asymptomatic or (rarely) may complain of suboccipital headache, light-headedness, tinnitus, and fatigue.
In malignant hypertension, diastolic pressure abruptly rises above 120 mm Hg, and systolic pressure may exceed 200 mm Hg. Typically, the patient has pulmonary edema marked by jugular vein distention, dyspnea, tachypnea, tachycardia, and a cough with pink, frothy sputum. Other characteristic signs and symptoms include severe headache, confusion, blurred vision, tinnitus, epistaxis, muscle twitching, chest pain, nausea, and vomiting.
Increased intracranial pressure (ICP)
Increased ICP causes an increased respiratory rate initially, followed by increased systolic pressure and widened pulse pressure. Increased ICP affects heart rate last, causing bradycardia (Cushing’s reflex). Associated signs and symptoms include headache, projectile vomiting, decreased level of consciousness, and fixed or dilated pupils.
Metabolic syndrome
Blood pressure that exceeds 135/85 mm Hg is one of the conditions associated with metabolic syndrome (previously called syndrome X). Other conditions that define this syndrome are obesity, abnormal cholesterol level, and high blood insulin level. Individuals with this combination of risk factors are at a significantly greater risk for developing heart disease, stroke, peripheral vascular disease, and type 2 diabetes. Factors contributing to these conditions include physical inactivity, excessive weight gain, and genetic predisposition. Self-care measures, such as exercising, following a heart-healthy diet, and not smoking, often combined with medical therapy, are essential treatments for this syndrome.
Myocardial infarction (MI)
MI is a life-threatening disorder that may cause high or low blood pressure. The most common symptom is crushing chest pain that may radiate to the jaw, shoulder, arm, or epigastrium. Other findings include dyspnea, anxiety, nausea, vomiting, weakness, diaphoresis, atrial gallop, and murmurs.
Pheochromocytoma
Paroxysmal or sustained elevated blood pressure characterizes pheochromocytoma and may be accompanied by orthostatic hypotension. Associated signs and symptoms include anxiety, diaphoresis, palpitations, tremors, pallor, nausea, weight loss, and headache.
Polycystic kidney disease
Elevated blood pressure is typically preceded by flank pain. Other signs and symptoms include enlarged kidneys, an enlarged and tender liver, and intermittent gross hematuria.
Preeclampsia and eclampsia
Potentially life threatening to the mother and fetus, preeclampsia and eclampsia characteristically increase blood pressure. They’re defined as a reading of 140/90 mm Hg or more in the first trimester, a reading of 130/80 mm Hg or more in the second or third trimester, an increase of 30 mm Hg above the patient’s baseline systolic pressure, or an increase of 15 mm Hg above the patient’s baseline diastolic pressure. Other findings include generalized edema, sudden weight gain of 3 lb (1.4 kg) or more per week during the second or third trimester, severe frontal headache, blurred or double vision, decreased urine output, proteinuria, midabdominal pain, neuromuscular irritability, nausea, and possibly seizures (eclampsia).
Renovascular stenosis
Renovascular stenosis produces abruptly elevated systolic and diastolic pressures. Other characteristic signs and symptoms include bruits over the upper abdomen or in the costovertebral angles, hematuria, and acute flank pain.
Thyrotoxicosis
Accompanying the elevated systolic pressure associated with thyrotoxicosis—a potentially life-threatening disorder—are widened pulse pressure, tachycardia, bounding pulse, pulsations in the capillary nail beds, palpitations, weight loss, exophthalmos, an enlarged thyroid gland, weakness, diarrhea, fever over 100° F (37.8° C), and warm, moist skin. The patient may appear nervous and emotionally unstable, displaying occasional outbursts or even psychotic behavior. Heat intolerance, exertional dyspnea and, in females, decreased or absent menses may also occur.
Other causes
Drugs
Central nervous system stimulants (such as amphetamines), sympathomimetics, corticosteroids, nonsteroidal anti-inflammatory drugs, hormonal contraceptives, monoamine oxidase inhibitors, and over-the-counter cold remedies can increase blood pressure, as can cocaine abuse.
Herb Alert
Ephedra (ma huang), ginseng, and licorice may cause high blood pressure or an irregular heartbeat. (Note:
The FDA has banned the sale of dietary supplements containing ephedra on the grounds that they pose an unreasonable risk of injury or illness.) St. John’s wort can also raise blood pressure, especially when taken with substances that antagonize hypericin, such as amphetamines, cold and hay fever medications, nasal decongestants, pickled foods, beer, coffee, wine, and chocolate.
Treatments
Kidney dialysis and transplantation cause transient elevation of blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Blood pressure decrease [Hypotension]:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Adrenal insufficiency (acute)
Orthostatic hypotension is characteristic in acute adrenal insufficiency and is accompanied by fatigue, weakness, nausea, vomiting, abdominal discomfort, weight loss, fever, and tachycardia. The patient may also have hyperpigmentation of fingers, nails, nipples, scars, and body folds; pale, cool, clammy skin; restlessness; decreased urine output; tachypnea; and coma.
Alcohol toxicity
Low blood pressure occurs infrequently in alcohol toxicity; more common signs and symptoms include a distinct alcohol breath odor, tachycardia, bradypnea, hypothermia, decreased LOC, seizures, staggering gait, nausea, vomiting, diuresis, and slow, stertorous breathing.
Anaphylactic shock
Following exposure to an allergen, such as penicillin or insect venom, a dramatic fall in blood pressure and narrowed pulse pressure signal this severe allergic reaction. Initially, anaphylactic shock causes anxiety, restlessness, a feeling of doom, intense itching (especially of the hands and feet), and a pounding headache. Later, it may also produce weakness, sweating, nasal congestion, coughing, difficulty breathing, nausea, abdominal cramps, involuntary defecation, seizures, flushing, urinary incontinence, tachycardia, and change or loss of voice due to laryngeal edema.
Anthrax, inhalation
Anthrax is an acute infectious disease that’s caused by the gram-positive, spore-forming bacterium Bacillus anthracis. Although the disease most commonly occurs in wild and domestic grazing animals, such as cattle, sheep, and goats, the spores can live in the soil for many years. The disease can occur in humans exposed to infected animals, tissue from infected animals, or biological agents. Most natural cases occur in agricultural regions worldwide. Anthrax may occur in cutaneous, inhalation, or GI forms.
Inhalation anthrax is caused by inhalation of aerosolized spores. Initial signs and symptoms are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial signs and symptoms. The second stage develops abruptly with rapid deterioration marked by fever, dyspnea, stridor, and hypotension generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetrical mediastinal widening.
Cardiac arrhythmias
In an arrhythmia, blood pressure may fluctuate between normal and low readings. Dizziness, chest pain, difficulty breathing, light-headedness, weakness, fatigue, and palpitations may also occur. Auscultation typically reveals an irregular rhythm and a pulse rate greater than 100 beats/minute or less than 60 beats/minute.
Cardiac contusion
In a cardiac contusion, low blood pressure occurs along with tachycardia and, at times, anginal pain and dyspnea.
Cardiac tamponade
An accentuated fall in systolic pressure (more than 10 mm Hg) during inspiration, known as paradoxical pulse, is characteristic in patients with cardiac tamponade. This disorder also causes restlessness, cyanosis, tachycardia, jugular vein distention, muffled heart sounds, dyspnea, and Kussmaul’s sign (increased venous distention with inspiration).
Cardiogenic shock
A fall in systolic pressure to less than 80 mm Hg, or to 30 mm Hg less than the patient’s baseline, because of decreased cardiac contractility is characteristic in patients with this disorder. Accompanying low blood pressure are tachycardia, narrowed pulse pressure, diminished Korotkoff sounds, peripheral cyanosis, and pale, cool, clammy skin. Cardiogenic shock also causes restlessness and anxiety, which may progress to disorientation and confusion. Associated signs and symptoms include angina, dyspnea, jugular vein distention, oliguria, ventricular gallop, tachypnea, and weak, rapid pulse.
Cholera
Cholera is an acute infection caused by the bacterium Vibrio cholerae that may be mild with uncomplicated diarrhea or severe and life-threatening. Cholera is spread by ingestion of contaminated water or food, especially shellfish. Signs include abrupt watery diarrhea and vomiting. Severe water and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.
Diabetic ketoacidosis
Hypovolemia triggered by osmotic diuresis in hyperglycemia is responsible for the low blood pressure associated with diabetic ketoacidosis, which is usually present in patients with type 1 diabetes mellitus. It also commonly produces polydipsia, polyuria, polyphagia, dehydration, weight loss, abdominal pain, nausea, vomiting, breath with fruity odor, Kussmaul’s respirations, tachycardia, seizures, confusion, and stupor that may progress to coma.
Heart failure
In heart failure, blood pressure may fluctuate between normal and low readings, but a precipitous drop in blood pressure may signal cardiogenic shock. Other signs and symptoms of heart failure include exertional dyspnea, dyspnea of abrupt or gradual onset, paroxysmal nocturnal dyspnea or difficulty breathing in the supine position (orthopnea), fatigue, weight gain, pallor or cyanosis, sweating, and anxiety. Auscultation
reveals ventricular gallop, tachycardia, bilateral crackles, and tachypnea. Dependent edema, jugular vein distention, increased capillary refill time, and hepatomegaly may also occur.
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
HHNS, which is common in persons with type 2 diabetes mellitus, decreases blood pressure—at times dramatically, if the patient loses significant fluid from diuresis due to severe hyperglycemia and hyperosmolarity. It also produces dry mouth, poor skin turgor, tachycardia, confusion progressing to coma and, occasionally, generalized tonic-clonic seizures.
Hypovolemic shock
A fall in systolic pressure to less than 80 mm Hg, or 30 mm Hg less than the patient’s baseline, secondary to acute blood loss or dehydration is characteristic in patients with hypovolemic shock. Accompanying it are diminished Korotkoff sounds, narrowed pulse pressure, and rapid, weak, and irregular pulse. Peripheral vasoconstriction causes cyanosis of the extremities and pale, cool, clammy skin. Other signs and symptoms include oliguria, confusion, disorientation, restlessness, and anxiety.
Hypoxemia
Initially, blood pressure may be normal or slightly elevated, but as hypoxemia becomes more pronounced blood pressure drops. The patient may also display tachycardia, tachypnea, dyspnea, confusion, and stupor that may progress to coma.
Myocardial infarction
In this life-threatening disorder, blood pressure may be low or high. However, a precipitous drop in blood pressure may signal cardiogenic shock. Associated signs and symptoms include chest pain that may radiate to the jaw, shoulder, arm, or epigastrium; dyspnea; anxiety; nausea or vomiting; sweating; and cool, pale, or cyanotic skin. Auscultation may reveal an atrial gallop, a murmur and, occasionally, an irregular pulse.
Neurogenic shock
The result of sympathetic denervation due to cervical injury or anesthesia, neurogenic shock produces low blood pressure and bradycardia. However, the patient’s skin remains warm and dry because of cutaneous vasodilation and sweat gland denervation. Depending on the cause of shock, motor weakness of the limbs or diaphragm may also occur.
Pulmonary embolism
Pulmonary embolism causes sudden, sharp chest pain and dyspnea accompanied by cough and, occasionally, low-grade fever. Low blood pressure occurs with narrowed pulse pressure and diminished Korotkoff sounds. Associated signs include tachycardia, tachypnea, paradoxical pulse, jugular vein distention, and hemoptysis.
Septic Shock
Initially, septic shock produces fever and chills. Low blood pressure, tachycardia, and tachypnea may also develop early, but the patient’s skin remains warm. Later, low blood pressure becomes increasingly severe—with systolic pressure less than 80 mm Hg, or 30 mm Hg less than the baseline—and is accompanied by narrowed pulse pressure. Other late signs and symptoms include pale skin, cyanotic extremities, apprehension, thirst, oliguria, and coma.
Vasovagal syncope
Vasovagal syncope is a transient loss or near-loss of consciousness that’s characterized by low blood pressure, pallor, cold sweats, nausea, palpitations or bradycardia, and weakness following stressful, painful, or claustrophobic experiences.
Other causes
Diagnostic tests
These include the gastric acid stimulation test using histamine and X-ray studies using contrast media. The latter may trigger an allergic reaction, which causes low blood pressure.
Drugs
Calcium channel blockers, diuretics, vasodilators, alpha- and beta-adrenergic blockers, general anesthetics, opioid analgesics, monoamine oxidase inhibitors, anxiolytics (such as benzodiazepines), tranquilizers, and most I.V. antiarrhythmics (especially bretylium tosylate) can cause low blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Leukemia, acute:
Causes
(Handbook of Diseases)
Research on predisposing factors is inconclusive, but points to some combination of viruses (viral remnants have been found in leukemic cells), genetic and immunologic factors, and exposure to radiation and certain chemicals.
Pathogenesis isn’t clearly understood, but immature, nonfunctioning WBCs appear to accumulate first in the tissue where they originate (lymphocytes in lymph tissue, granulocytes in bone marrow). These immature WBCs then spill into the bloodstream and from there infiltrate other tissues, eventually causing organ malfunction because of encroachment or hemorrhage. (See What happens in leukemia.)
Incidence
Acute leukemia is more common in males than in females, in whites (especially people of Jewish descent), in children between ages 2 and 5 (80% of all leukemias in this age-group are ALL), and in people who live in urban and industrialized areas. Acute leukemia ranks 20th in causes of cancer-related deaths among people of all age-groups. Among children, however, it’s the most common form of cancer.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Leukemia, chronic lymphocytic:
Causes
(Handbook of Diseases)
Although the cause of chronic lymphocytic leukemia is unknown, researchers suspect hereditary factors (higher incidence has been recorded within families), still-undefined chromosome abnormalities, and certain immunologic defects (such as ataxia-telangiectasia or acquired agammaglobulinemia). The disease doesn’t seem to be associated with radiation exposure.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Leukemia, chronic granulocytic:
Causes
(Handbook of Diseases)
CGL’s exact cause is unknown. However, almost 90% of patients with CGL have the Philadelphia (Ph1) chromosome, an abnormality discovered in 1960 in which the long arm of chromosome 22 is translocated, usually to chromosome 9. Radiation and carcinogenic chemicals may cause this chromosome abnormality. Myeloproliferative diseases also seem to increase the incidence of CGL, and some physicians suspect that an unidentified virus causes this disease.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Blood pressure decrease:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Acute adrenal insufficiency
Orthostatic hypotension is characteristic with acute adrenal insufficiency, accompanied by fatigue, weakness, nausea, vomiting, abdominal discomfort, weight loss, fever, and tachycardia. The patient may also have hyperpigmentation of fingers, nails, nipples, scars, and body folds; pale, cool, clammy skin; restlessness; decreased urine output; tachypnea; and coma.
Alcohol toxicity
Low blood pressure occurs infrequently; more commonly, alcohol toxicity produces distinct alcohol breath odor, tachycardia, bradypnea, hypothermia, decreased LOC, seizures, staggering gait, nausea, vomiting, diuresis, and slow, stertorous breathing.
Anaphylactic shock
Following exposure to an allergen, such as penicillin or insect venom, a dramatic fall in blood pressure and narrowed pulse pressure signal anaphylactic shock, a severe allergic reaction. Initially, it causes anxiety, restlessness, a feeling of doom, intense itching (especially of the hands and feet), and pounding headache. Later, it may also produce weakness, sweating, nasal congestion, coughing, difficulty breathing, nausea, abdominal cramps, involuntary defecation, seizures, flushing, change or loss of voice due to laryngeal edema, urinary incontinence, and tachycardia.
Anthrax (inhalation)
Anthrax is an acute infectious disease that’s caused by the gram-positive, spore-forming bacterium Bacillus anthracis. Although the disease most commonly occurs in wild and domestic grazing animals, such as cattle, sheep, and goats, the spores can live in the soil for many years. The disease can occur in humans exposed to infected animals, tissue from infected animals, or biological warfare. Most natural cases occur in agricultural regions worldwide. Anthrax may occur in cutaneous, inhalation, or GI form.
Inhalation anthrax is caused by inhaling aerosolized spores. Initial signs and symptoms are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial signs and symptoms. The second stage develops abruptly with rapid deterioration marked by fever, dyspnea, stridor, and hypotension generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.
Cardiac arrhythmias
With an arrhythmia, blood pressure may fluctuate between normal and low readings. Dizziness, chest pain, difficulty breathing, light-headedness, weakness, fatigue, and palpitations may also occur. Auscultation typically reveals an irregular rhythm and a pulse rate greater than 100 beats/minute or less than 60 beats/minute.
Cardiac contusion
With cardiac contusion, low blood pressure occurs along with tachycardia and, at times, anginal pain and dyspnea.
Cardiac tamponade
An accentuated fall in systolic pressure (more than 10 mm Hg) during inspiration, known as paradoxical pulse, is characteristic in patients with cardiac tamponade. This disorder also causes restlessness, cyanosis, tachycardia, jugular vein distention, muffled heart sounds, dyspnea, and Kussmaul’s sign (increased venous distention with inspiration).
Cardiogenic shock
A fall in systolic pressure to less than 80 mm Hg or to 30 mm Hg less than the patient’s baseline, because of decreased cardiac contractility, is characteristic in patients with cardiogenic shock. Accompanying low blood pressure are tachycardia, narrowed pulse pressure, diminished Korotkoff sounds, peripheral cyanosis, and pale, cool, clammy skin. Cardiogenic shock also causes restlessness and anxiety, which may progress to disorientation and confusion. Associated signs and symptoms include angina, dyspnea, jugular vein distention, oliguria, ventricular gallop, tachypnea, and weak, rapid pulse.
Cholera
Cholera is an acute infection caused by the bacterium Vibrio cholerae that may be mild with uncomplicated diarrhea or severe and life threatening. Cholera is spread by ingestion of contaminated water or food, especially shellfish. Signs include abrupt watery diarrhea and vomiting. Severe water and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.
Diabetic ketoacidosis (DKA)
Hypovolemia triggered by osmotic diuresis in hyperglycemia is responsible for the low blood pressure associated with DKA, which is usually present in patients with type 1 diabetes mellitus. It also commonly produces polydipsia, polyuria, polyphagia, dehydration, weight loss, abdominal pain, nausea, vomiting, fruity breath odor, Kussmaul’s respirations, tachycardia, seizures, confusion, and stupor that may progress to coma.
Heart failure
With heart failure, blood pressure may fluctuate between normal and low readings. However, a precipitous drop in blood pressure may signal cardiogenic shock. Other signs and symptoms of heart failure include exertional dyspnea, dyspnea of abrupt or gradual onset, paroxysmal nocturnal dyspnea or difficulty breathing in the supine position (orthopnea), fatigue, weight gain, pallor or cyanosis, sweating, and anxiety. Auscultation reveals ventricular gallop, tachycardia, bilateral crackles, and tachypnea. Dependent edema, jugular vein distention, increased capillary refill time, and hepatomegaly may also occur.
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
HHNS, which is common in people with type 2 diabetes mellitus, decreases blood pressure — at times dramatically, if the patient loses significant fluid from diuresis due to severe hyperglycemia and hyperosmolarity. It also produces dry mouth, poor skin turgor, tachycardia, confusion progressing to coma and, occasionally, generalized tonic-clonic seizure.
Hypovolemic shock
A fall in systolic pressure to less than 80 mm Hg or 30 mm Hg less than the patient’s baseline, secondary to acute blood loss or dehydration, is characteristic in patients with hypovolemic shock. Accompanying it are diminished Korotkoff sounds, narrowed pulse pressure, and rapid, weak, and irregular pulse. Peripheral vasoconstriction causes cyanosis of the extremities and pale, cool, clammy skin. Other signs and symptoms include oliguria, confusion, disorientation, restlessness, and anxiety.
Hypoxemia
Initially, blood pressure may be normal or slightly elevated, but as hypoxemia becomes more pronounced, blood pressure drops. The patient may also display tachycardia, tachypnea, dyspnea, and confusion, and may progress from stupor to coma.
Myocardial infarction (MI)
With MI — a life-threatening disorder — blood pressure may be low or high. However, a precipitous drop in blood pressure may signal cardiogenic shock. Associated signs and symptoms include chest pain that may radiate to the jaw, shoulder, arm, back, or epigastrium; dyspnea; anxiety; nausea or vomiting; sweating; and cool, pale, or cyanotic skin. Auscultation may reveal an atrial gallop, a murmur and, occasionally, an irregular pulse.
Neurogenic shock
. The result of sympathetic denervation due to cervical injury or anesthesia, neurogenic shock produces low blood pressure and bradycardia. However, the patient’s skin remains warm and dry because of cutaneous vasodilation and sweat gland denervation. Depending on the cause of shock, there may also be motor weakness of the limbs or diaphragm.
Pulmonary embolism
Pulmonary embolism causes sudden, sharp chest pain and dyspnea accompanied by cough and, occasionally, low-grade fever. Low blood pressure occurs with narrowed pulse pressure and diminished Korotkoff sounds. Associated signs include tachycardia, tachypnea, paradoxical pulse, jugular vein distention, and hemoptysis.
Septic shock
Initially, septic shock produces fever and chills. Low blood pressure, tachycardia, and tachypnea may also develop early, but the patient’s skin remains warm. Later, low blood pressure becomes increasingly severe — less than 80 mm Hg, or 30 mm Hg less than the patient’s baseline — and is accompanied by narrowed pulse pressure. Other late signs and symptoms include pale skin, cyanotic extremities, apprehension, thirst, oliguria, and coma.
Vasovagal syncope
Vasovagal syncope is a transient attack of loss or near-loss of consciousness that’s characterized by low blood pressure, pallor, cold sweats, nausea, palpitations or slowed heart rate, and weakness following stressful, painful, or claustrophobic experiences.
Other causes
Diagnostic tests
These include the gastric acid stimulation test using histamine and X-ray studies using contrast media. The latter may trigger an allergic reaction, which causes low blood pressure.
Drugs
Calcium channel blockers, diuretics, vasodilators, alpha- and beta-adrenergic blockers, general anesthetics, opioid analgesics, monoamine oxidase inhibitors, anxiolytics (such as benzodiazepines), tranquilizers, and most I.V. antiarrhythmics can cause low blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Blood pressure increase:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Aldosteronism (primary)
With aldosteronism, elevated diastolic pressure may be accompanied by orthostatic hypotension. Other findings include constipation, muscle weakness, polyuria, polydipsia, and personality changes.
Anemia
Accompanying elevated systolic pressure in anemia are pulsations in the capillary beds, bounding pulse, tachycardia, systolic ejection murmur, pale mucous membranes and, in patients with sickle cell anemia, ventricular gallop and crackles.
Aortic aneurysm (dissecting)
Initially, aortic aneurysm — a life-threatening disorder — causes a sudden rise in systolic pressure (which may be the precipitating event), but no change in diastolic pressure. However, this increase is brief. The body’s ability to compensate fails, resulting in hypotension.
Other signs and symptoms vary, depending on the type of aortic aneurysm. An abdominal aneurysm may cause persistent abdominal and back pain, weakness, sweating, tachycardia, dyspnea, a pulsating abdominal mass, restlessness, confusion, and cool, clammy skin. A thoracic aneurysm may cause a ripping or tearing sensation in the chest, which may radiate to the neck, shoulders, lower back, or abdomen; pallor; syncope; blindness; loss of consciousness; sweating; dyspnea; tachycardia; cyanosis; leg weakness; murmur; and absent radial and femoral pulses.
Atherosclerosis
With atherosclerosis, systolic pressure rises while diastolic pressure commonly remains normal or slightly elevated. The patient may show no other signs, or he may have a weak pulse, flushed skin, tachycardia, angina, and claudication.
Cushing’s syndrome
Twice as common in females as in males, Cushing’s syndrome causes elevated blood pressure and widened pulse pressure as well as truncal obesity, moon face, and other cushingoid signs. It’s usually caused by corticosteroid use.
Hypertension
Essential hypertension develops insidiously and is characterized by a gradual increase in blood pressure from decade to decade. Except for this high blood pressure, the patient may be asymptomatic or (rarely) may complain of suboccipital headache, light-headedness, tinnitus, and fatigue.
With malignant hypertension, diastolic pressure abruptly rises above 120 mm Hg, and systolic pressure may exceed 200 mm Hg. Typically, the patient has pulmonary edema marked by jugular vein distention, dyspnea, tachypnea, tachycardia, and coughing up pink, frothy sputum. Other characteristic signs and symptoms include severe headache, confusion, blurred vision, tinnitus, epistaxis, muscle twitching, chest pain, nausea, and vomiting.
Increased ICP
Increased ICP causes an increased respiratory rate initially, followed by increased systolic pressure and widened pulse pressure. Increased ICP affects heart rate last, causing bradycardia (Cushing’s reflex). Associated signs and symptoms include headache, projectile vomiting, decreased level of consciousness, and fixed or dilated pupils.
Myocardial infarction (MI)
MI — a life-threatening disorder — may cause high or low blood pressure. Common findings include crushing chest pain that may radiate to the jaw, shoulder, arm, back, or epigastrium. Other findings include dyspnea, anxiety, nausea, vomiting, weakness, diaphoresis, atrial gallop, and murmurs.
Pheochromocytoma
Paroxysmal or sustained elevated blood pressure characterizes pheochromocytoma and may be accompanied by orthostatic hypotension. Associated signs and symptoms include anxiety, diaphoresis, palpitations, tremors, pallor, nausea, weight loss, and headache.
Polycystic kidney disease
Elevated blood pressure is typically preceded by flank pain. Other signs and symptoms include enlarged kidneys; enlarged, tender liver; and intermittent gross hematuria.
Preeclampsia and eclampsia
Potentially life threatening to the mother and fetus, preeclampsia and eclampsia characteristically increase blood pressure. They’re defined as a reading of 140/90 mm Hg or more in the first trimester, a reading of 130/80 mm Hg or more in the second or third trimester, an increase of 30 mm Hg above the patient’s baseline systolic pressure, or an increase of 15 mm Hg above the patient’s baseline diastolic pressure. Accompanying elevated blood pressure are generalized edema, sudden weight gain of 3 lb (1.4 kg) or more per week during the second or third trimester, severe frontal headache, blurred or double vision, decreased urine output, proteinuria, midabdominal pain, neuromuscular irritability, nausea, and possibly seizures (eclampsia).
Renovascular stenosis
Renovascular stenosis produces abruptly elevated systolic and diastolic pressures. Other characteristic signs and symptoms include bruits over the upper abdomen or in the CVAs, hematuria, and acute flank pain.
Thyrotoxicosis
Accompanying the elevated systolic pressure associated with thyrotoxicosis — a potentially life-threatening disorder — are widened pulse pressure, tachycardia, bounding pulse, pulsations in the capillary nail beds, palpitations, weight loss, exophthalmos, an enlarged thyroid gland, weakness, diarrhea, fever over 100° F (37.8° C), and warm, moist skin. The patient may appear nervous and emotionally unstable, displaying occasional outbursts or even psychotic behavior. Heat intolerance, exertional dyspnea and, in females, decreased or absent menses may also occur.
Other causes
Drugs
Central nervous system stimulants (such as amphetamines), sympathomimetics, corticosteroids, nonsteroidal anti-inflammatory drugs, hormonal contraceptives, monoamine oxidase inhibitors, and OTC cold remedies can increase blood pressure, as can cocaine abuse.
Herbal supplements
. Ephedra (ma huang), ginseng, and licorice may cause high blood pressure or an irregular heartbeat. St. John’s wort can also raise blood pressure, especially when taken with substances that antagonize hypericin, such as amphetamines, cold and hay fever medications, nasal decongestants, pickled foods, beer, coffee, wine, and chocolate.
Treatments
Kidney dialysis and transplantation cause transient elevation of blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Blood pressure decrease:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Acute adrenal insufficiency
Orthostatic hypotension is characteristic of acute adrenal insufficiency. It’s accompanied by fatigue, weakness, nausea, vomiting, abdominal discomfort, weight loss, fever, and tachycardia. The patient may also have hyperpigmentation of fingers, nails, nipples, scars, and body folds; pale, cool, clammy skin; restlessness; decreased urine output; tachypnea; and coma.
Anaphylactic shock
Following exposure to an allergen, such as penicillin or insect venom, a dramatic fall in blood pressure and narrowed pulse pressure signal anaphylactic shock. Initially, this severe allergic reaction causes anxiety, restlessness, a feeling of doom, intense itching (especially of the hands and feet), and pounding headache. Later, it may also produce weakness, sweating, nasal congestion, coughing, difficulty breathing, nausea, abdominal cramps, involuntary defecation, seizures, flushing, change or loss of voice due to laryngeal edema, urinary incontinence, and tachycardia.
Anthrax (inhalation)
Inhalation anthrax is caused by inhalation of aerosolized spores of the gram-positive bacterium Bacillus anthracis. Initial signs and symptoms are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial signs and symptoms. The second stage develops abruptly with rapid deterioration marked by fever, dyspnea, stridor, and hypotension generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.
Cardiac arrhythmia
With a cardiac arrhythmia, blood pressure may fluctuate between normal and low readings. Dizziness, chest pain, difficulty breathing, light-headedness, weakness, fatigue, and palpitations may also occur. Auscultation typically reveals an irregular rhythm and a pulse rate greater than 100 beats/minute or less than 60 beats/minute.
Cardiac tamponade
An accentuated fall in systolic pressure (more than 10 mm Hg) during inspiration, known as paradoxical pulse, is characteristic in patients with cardiac tamponade. This disorder also causes restlessness, cyanosis, tachycardia, jugular vein distention, muffled heart sounds, dyspnea, and Kussmaul’s sign (increased venous distention with inspiration).
Cardiogenic shock
A fall in systolic pressure to less than 80 mm Hg or to 30 mm Hg less than the patient’s baseline, because of decreased cardiac contractility, is characteristic in patients with cardiogenic shock. Accompanying low blood pressure are tachycardia, narrowed pulse pressure, diminished Korotkoff sounds, peripheral cyanosis, and pale, cool, clammy skin. Cardiogenic shock also causes restlessness and anxiety, which may progress to disorientation and confusion. Associated signs and symptoms include angina, dyspnea, jugular vein distention, oliguria, ventricular gallop, tachypnea, and weak, rapid pulse.
Cholera
Cholera, an acute infection that’s caused by the bacterium Vibrio cholerae, may be mild with uncomplicated diarrhea or severe and life-threatening. Signs include abrupt watery diarrhea and vomiting. Severe water and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.
Diabetic ketoacidosis
Hypovolemia triggered by osmotic diuresis in hyperglycemia is responsible for the low blood pressure associated with diabetic ketoacidosis, which is usually present in patients with type 1 diabetes mellitus. It also commonly produces polydipsia, polyuria, polyphagia, dehydration, weight loss, abdominal pain, nausea, vomiting, breath with fruity odor, Kussmaul’s respirations, tachycardia, seizures, confusion, and stupor that may progress to coma.
Heart failure
With heart failure, blood pressure may fluctuate between normal and low readings. However, a precipitous drop in blood pressure may signal cardiogenic shock. Other signs and symptoms of heart failure include exertional dyspnea, dyspnea of abrupt or gradual onset, paroxysmal nocturnal dyspnea or difficulty breathing in the supine position (orthopnea), fatigue, weight gain, pallor or cyanosis, sweating, and anxiety. Auscultation reveals ventricular gallop, tachycardia, bilateral crackles, and tachypnea. Dependent edema, jugular vein distention, increased capillary refill time, and hepatomegaly may also occur.
Hypovolemic shock
A fall in systolic pressure to less than 80 mm Hg or 30 mm Hg less than the patient’s baseline, secondary to acute blood loss or dehydration, is characteristic in patients with hypovolemic shock. Accompanying it are diminished Korotkoff sounds, narrowed pulse pressure, and rapid, weak, and irregular pulse. Peripheral vasoconstriction causes cyanosis of the extremities and pale, cool, clammy skin. Other signs and symptoms include oliguria, confusion, disorientation, restlessness, and anxiety.
Hypoxemia
Initially, blood pressure may be normal or slightly elevated, but as hypoxemia becomes more pronounced blood pressure drops. The patient may also display tachycardia, tachypnea, dyspnea, and confusion, and may progress from stupor to coma.
Myocardial infarction
With myocardial infarction (MI), a life-threatening disorder, blood pressure may be low or high. However, a precipitous drop in blood pressure may signal cardiogenic shock. Associated signs and symptoms of MI include chest pain that may radiate to the jaw, shoulder, arm, or epigastrium; dyspnea; anxiety; nausea or vomiting; sweating; and cool, pale, or cyanotic skin. Auscultation may reveal an atrial gallop, a murmur and, occasionally, an irregular pulse.
Neurogenic shock
The result of sympathetic denervation due to cervical injury or anesthesia, neurogenic shock produces low blood pressure and bradycardia. However, the patient’s skin remains warm and dry because of cutaneous vasodilation and sweat gland denervation. Depending on the cause of shock, there may also be motor weakness of the limbs or diaphragm.
Pulmonary embolism
Pulmonary embolism causes sudden, sharp chest pain and dyspnea accompanied by cough and, occasionally, low-grade fever. Low blood pressure occurs with narrowed pulse pressure and diminished Korotkoff sounds. Associated signs include tachycardia, tachypnea, paradoxical pulse, jugular vein distention, and hemoptysis.
Septicshock
Initially, septic shock produces fever and chills. Low blood pressure, tachycardia, and tachypnea may also develop early, but the patient’s skin remains warm. Later, low blood pressure becomes increasingly severe — less than 80 mm Hg, or 30 mm Hg less than the patient’s baseline — and is accompanied by narrowed pulse pressure. Other late signs and symptoms include pale skin, cyanotic extremities, apprehension, thirst, oliguria, and coma.
Vasovagal syncope
Vasovagal syncope, a transient attack of loss or near-loss of consciousness, is characterized by low blood pressure, pallor, cold sweats, nausea, palpitations or slowed heart rate, and weakness following stressful, painful, or claustrophobic experiences.
Other causes
Diagnostic tests
Diagnostic tests that may cause low blood pressure include the gastric acid stimulation test using histamine and X-ray studies using contrast media. The latter may trigger an allergic reaction, which causes low blood pressure.
Drugs
Calcium channel blockers, diuretics, vasodilators, alpha- and beta-adrenergic blockers, general anesthetics, opioid analgesics, monoamine oxidase inhibitors, anxiolytics (such as benzodiazepines), tranquilizers, and most I.V. antiarrhythmics can cause low blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Blood pressure increase:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Anemia
Elevated systolic pressure in anemia is accompanied by pulsations in the capillary beds, bounding pulse, tachycardia, systolic ejection murmur, pale mucous membranes and, in patients with sickle cell anemia, ventricular gallop and crackles.
Aortic aneurysm (dissecting)
Initially, dissecting aortic aneurysm causes a sudden rise in systolic pressure (which may be the precipitating event) but causes no change in diastolic pressure. However, this increase is brief. The body’s ability to compensate fails, resulting in hypotension.
Other signs and symptoms of this life-threatening disorder vary, depending on the type of aortic aneurysm. An abdominal aneurysm may cause persistent abdominal and back pain, weakness, sweating, tachycardia, dyspnea, a pulsating abdominal mass, restlessness, confusion, and cool, clammy skin. A thoracic aneurysm may cause a ripping or tearing sensation in the chest, which may radiate to the neck, shoulders, lower back, or abdomen; pallor; syncope; blindness; loss of consciousness; sweating; dyspnea; tachycardia; cyanosis; leg weakness; murmur; and absent radial and femoral pulses.
Atherosclerosis
With atherosclerosis, systolic pressure rises, whereas diastolic pressure commonly remains normal or slightly elevated. The patient may show no other signs, or he may have a weak pulse, flushed skin, tachycardia, angina, and claudication.
Cushing’s syndrome
Twice as common in females as in males, Cushing’s syndrome causes elevated blood pressure and widened pulse pressure as well as truncal obesity, moon face, and other cushingoid signs. It’s usually caused by corticosteroid use.
Hypertension
Essential hypertension develops insidiously and is characterized by a gradual increase in blood pressure from decade to decade. Except for this high blood pressure, the patient may be asymptomatic or (rarely) may complain of suboccipital headache, light-headedness, tinnitus, and fatigue.
With malignant hypertension, diastolic pressure abruptly rises above 120 mm Hg, and systolic pressure may exceed 200 mm Hg. Typically, the patient has pulmonary edema marked by jugular vein distention, dyspnea, tachypnea, tachycardia, and coughing of pink, frothy sputum. Other characteristic signs and symptoms include severe headache, confusion, blurred vision, tinnitus, epistaxis, muscle twitching, chest pain, nausea, and vomiting.
Increased intracranial pressure
Increased intracranial pressure (ICP) causes an increased respiratory rate initially, followed by increased systolic pressure and widened pulse pressure. It affects heart rate last, causing bradycardia (Cushing’s reflex). Associated signs and symptoms of increased ICP include headache, projectile vomiting, decreased level of consciousness, and fixed or dilated pupils.
Myocardial infarction
Myocardial infarction is a life-threatening disorder that can cause high or low blood pressure. Common findings include crushing chest pain that may radiate to the jaw, shoulder, arm, or epigastrium. Other findings include dyspnea, anxiety, nausea, vomiting, weakness, diaphoresis, atrial gallop, and murmurs.
Pheochromocytoma
Paroxysmal or sustained elevated blood pressure characterizes pheochromocytoma and may be accompanied by orthostatic hypotension. Associated signs and symptoms include anxiety, diaphoresis, palpitations, tremors, pallor, nausea, weight loss, and headache.
In advanced stages, this disease may cause concurrent hematuria, life-threatening retroperitoneal bleeding, resulting from cyst rupture, proteinuria, and colicky abdominal pain from the ureteral passage of clots of calculi.
Preeclampsia and eclampsia
Potentially life-threatening to the patient and her fetus, preeclampsia and eclampsia characteristically increase blood pressure. They’re defined as a reading of 140/90 mm Hg or more in the first trimester, a reading of 130/80 mm Hg or more in the second or third trimester, an increase of 30 mm Hg above the patient’s baseline systolic pressure, or an increase of 15 mm Hg above the patient’s baseline diastolic pressure. Accompanying elevated blood pressure are generalized edema, sudden weight gain of 3 lb (1.4 kg) or more per week during the second or third trimester, severe frontal headache, blurred or double vision, decreased urine output, proteinuria, midabdominal pain, neuromuscular irritability, nausea and, possibly, seizures (eclampsia).
Renovascular stenosis
Renovascular stenosis produces abruptly elevated systolic and diastolic pressures. Other characteristic signs and symptoms include bruits over the upper abdomen or in the costovertebral angles, hematuria, and acute flank pain.
Thyrotoxicosis
A potentially life-threatening disorder, thyrotoxicosis is accompanied by elevated systolic pressure, widened pulse pressure, tachycardia, bounding pulse, pulsations in the capillary nail beds, palpitations, weight loss, exophthalmos, an enlarged thyroid gland, weakness, diarrhea, fever over 100° F (37.8° C), and warm, moist skin. The patient may appear nervous and emotionally unstable, displaying occasional outbursts or even psychotic behavior. Heat intolerance, exertional dyspnea and, in females, decreased or absent menses may also occur.
Other causes
Drugs
Central nervous system stimulants (such as amphetamines), sympathomimetics, corticosteroids, nonsteroidal anti-inflammatories, hormonal contraceptives, monoamine oxidase inhibitors, and over-the-counter cold remedies can increase blood pressure, as can cocaine abuse.
Treatments
Kidney dialysis and transplantation cause transient elevation of blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Blood pressure, decreased [Hypotension]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute adrenal insufficiency.Orthostatic hypotension is characteristic with acute adrenal insufficiency, accompanied by fatigue, weakness, nausea, vomiting, abdominal discomfort, weight loss, fever, and tachycardia. The patient may also have hyperpigmentation of fingers, nails, nipples, scars, and body folds; pale, cool, clammy skin; restlessness; decreased urine output; tachypnea; and coma.
Anaphylactic shock.Following exposure to an allergen, such as penicillin or insect venom, a dramatic fall in blood pressure and narrowed pulse pressure signal anaphylactic reaction. Initially, anaphylactic shock causes anxiety, restlessness, a feeling of doom, intense itching (especially of the hands and feet), and pounding headache. Later, it may also produce weakness, sweating, nasal congestion, coughing, difficulty breathing, nausea, abdominal cramps, involuntary defecation, seizures, flushing, change or loss of voice due to laryngeal edema, urinary incontinence, and tachycardia.
Anthrax (inhalation).Inhalation anthrax is caused by inhalation of aerosolized spores. Initial signs and symptoms are flulike and include fever, chills, weakness, cough, and chest pain. The disease generally occurs in two stages with a period of recovery after the initial signs and symptoms. The second stage develops abruptly with rapid deterioration marked by fever, dyspnea, stridor, and hypotension, generally leading to death within 24 hours. Radiologic findings include mediastinitis and symmetric mediastinal widening.
Cardiac arrhythmias.With an arrhythmia, blood pressure may fluctuate between normal and low readings. Dizziness, chest pain, difficulty breathing, light-headedness, weakness, fatigue, and palpitations may also occur. Auscultation typically reveals an irregular rhythm and a pulse rate greater than 100 beats/ minute or less than 60 beats/minute. A life-threatening arrhythmia may cause absence of a pulse and no palpable blood pressure and requires emergency resuscitation measures.
Cardiac contusion.With cardiac contusion, low blood pressure occurs along with tachycardia and, at times, anginal pain and dyspnea.
Cardiac tamponade.An accentuated fall in systolic pressure (more than 10 mm Hg) during inspiration, known as paradoxical pulse, is characteristic in patients with cardiac tamponade. This disorder also causes restlessness, cyanosis, tachycardia, jugular vein distention, muffled heart sounds, dyspnea, and Kussmaul's sign (increased venous distention with inspiration).
Cardiogenic shock.A fall in systolic pressure to less than 80 mm Hg or to 30 mm Hg less than the patient's baseline because of decreased cardiac contractility is characteristic in patients with cardiogenic shock. Accompanying low blood pressure are tachycardia, narrowed pulse pressure, diminished Korotkoff sounds, peripheral cyanosis, and pale, cool, clammy skin. Cardiogenic shock also causes restlessness and anxiety, which may progress to disorientation and confusion. Associated signs and symptoms include angina, dyspnea, jugular vein distention, oliguria, ventricular gallop, tachypnea, and a weak, rapid pulse.
Cholera.Cholera may be mild and with uncomplicated diarrhea or severe and life-threatening. Signs include abrupt watery diarrhea and vomiting. Severe fluid and electrolyte loss leads to thirst, weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.
Diabetic ketoacidosis.Hypovolemia triggered by osmotic diuresis in hyperglycemia is responsible for the low blood pressure associated with diabetic ketoacidosis, which is usually present in patients with type 1 diabetes mellitus. It commonly produces polydipsia, polyuria, polyphagia, dehydration, weight loss, abdominal pain, nausea, vomiting, breath with fruity odor, Kussmaul's respirations, tachycardia, seizures, confusion, and stupor that may progress to coma.
Heart failure.With heart failure, blood pressure may fluctuate between normal and low readings. A precipitous drop in blood pressure may signal cardiogenic shock. Other signs and symptoms of heart failure include exertional dyspnea, dyspnea of abrupt or gradual onset, paroxysmal nocturnal dyspnea or difficulty breathing in the supine position (orthopnea), fatigue, weight gain, pallor or cyanosis, sweating, and anxiety. Auscultation reveals ventricular gallop, tachycardia, bilateral crackles, and tachypnea. Dependent edema, jugular vein distention, increased capillary refill time, and hepatomegaly may also occur.
Hyperosmolar hyperglycemic
nonketotic syndrome (HHNS).HHNS, which is common in the patient with type 2 diabetes mellitus, decreases blood pressure—at times dramatically—if he loses significant fluid from diuresis due to severe hyperglycemia and hyperosmolarity. It also produces dry mouth, poor skin turgor, tachycardia, confusion progressing to coma and, occasionally, generalized tonic-clonic seizure.
Hypovolemic shock.A fall in systolic pressure to less than 80 mm Hg or 30 mm Hg less than the patient's baseline, secondary to acute blood loss or dehydration, is characteristic in hypovolemic shock. Accompanying it are diminished Korotkoff sounds, a narrowed pulse pressure, and a rapid, weak, and irregular pulse. Peripheral vasoconstriction causes cyanosis of the extremities and pale, cool, clammy skin. Other signs and symptoms include oliguria, confusion, disorientation, restlessness, and anxiety.
Hypoxemia.Initially, blood pressure may be normal or slightly elevated, but as hypoxemia becomes more pronounced, blood pressure drops. The patient may display tachycardia, tachypnea, dyspnea, and confusion and may progress from stupor to coma.
Myocardial infarction (MI).With MI, a life-threatening disorder, blood pressure may be low or high. A precipitous drop in blood pressure may signal cardiogenic shock. Associated signs and symptoms include chest pain that may radiate to the jaw, shoulder, arm, or epigastrium; dyspnea; anxiety; nausea or vomiting; sweating; and cool, pale, or cyanotic skin. Auscultation may reveal an atrial gallop, a murmur and, occasionally, an irregular pulse.
Neurogenic shock.The result of sympathetic denervation due to cervical injury or anesthesia, neurogenic shock produces low blood pressure and bradycardia. The patient's skin remains warm and dry because of cutaneous vasodilation and sweat gland denervation. Depending on the cause of shock, there may also be motor weakness of the limbs or diaphragm.
Pulmonary embolism.Pulmonary embolism causes sudden, sharp chest pain and dyspnea accompanied by a cough and, occasionally, a low-grade fever. Low blood pressure occurs with a narrowed pulse pressure and diminished Korotkoff sounds. Associated signs include tachycardia, tachypnea, a paradoxical pulse, jugular vein distention, and hemoptysis.
Septic shock.Initially, septic shock produces fever and chills. Low blood pressure, tachycardia, and tachypnea may also develop early, but the patient's skin remains warm. Low blood pressure becomes increasingly severe—less than 80 mm Hg or 30 mm Hg less than the patient's baseline—and is accompanied by narrowed pulse pressure. Other late signs and symptoms include pale skin, cyanotic extremities, apprehension, thirst, oliguria, and coma.
Vasovagal syncope.Vasovagal syncope is the transient loss or near-loss of consciousness that's characterized by low blood pressure, pallor, cold sweats, nausea, palpitations or slowed heart rate, and weakness following stressful, painful, or claustrophobic experiences.
Other causes
Diagnostic tests.Diagnostic tests include the gastric acid stimulation test using histamine and X-ray studies using contrast media. The latter may trigger an allergic reaction, which causes low blood pressure.
Drugs.Calcium channel blockers, diuretics, vasodilators, alpha- and beta-adrenergic blockers, general anesthetics, opioid analgesics, monoamine oxidase inhibitors, anxiolytics (such as benzodiazepines), tranquilizers, and most I.V. antiarrhythmics (especially bretylium tosylate) can cause low blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Blood pressure, increased [Hypertension]:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Anemia.Accompanying elevated systolic pressure in anemia are pulsations in the capillary beds, bounding pulse, tachycardia, systolic ejection murmur, pale mucous membranes and, in patients with sickle cell anemia, ventricular gallop and crackles.
Aortic aneurysm (dissecting).Initially, this life-threatening disorder causes a sudden rise in systolic pressure (which may be the precipitating event), but no change in diastolic pressure; however, this increase is brief. The body's ability to compensate fails, resulting in hypotension.
Other signs and symptoms vary, depending on the type of aortic aneurysm. An abdominal aneurysm may cause persistent abdominal and back pain, weakness, sweating, tachycardia, dyspnea, a pulsating abdominal mass, restlessness, confusion, and cool, clammy skin. A thoracic aneurysm may cause a ripping or tearing sensation in the chest, which may radiate to the neck, shoulders, lower back, or abdomen; pallor; syncope; blindness; loss of consciousness; sweating; dyspnea; tachycardia; cyanosis; leg weakness; murmur; and absent radial and femoral pulses.
Atherosclerosis.With atherosclerosis, systolic pressure rises while diastolic pressure commonly remains normal or slightly elevated. The patient may show no other signs, or he may have a weak pulse, flushed skin, tachycardia, angina, and claudication.
Cushing's syndrome.Cushing's syndrome causes elevated blood pressure and widened pulse pressure as well as truncal obesity, moon face, and other cushingoid signs. It's usually caused by corticosteroid use.
Hypertension.Essential hypertension develops insidiously and is characterized by a gradual increase in blood pressure from decade to decade. Except for this high blood pressure, the patient may be asymptomatic or (rarely) may complain of suboccipital headache, light-headedness, tinnitus, and fatigue.
With malignant hypertension, diastolic pressure abruptly rises above 120 mm Hg, and systolic pressure may exceed 200 mm Hg. Typically, the patient has pulmonary edema marked by jugular vein distention, dyspnea, tachypnea, tachycardia, and coughing of pink, frothy sputum. Other characteristic signs and symptoms include severe headache, confusion, blurred vision, tinnitus, epistaxis, muscle twitching, chest pain, nausea, and vomiting.
Increased intracranial pressure (ICP).Increased ICP causes an increased respiratory rate initially, followed by increased systolic pressure and widened pulse pressure. Increased ICP affects the heart rate last, causing bradycardia (Cushing's reflex). Associated signs and symptoms include headache, projectile vomiting, a decreased level of consciousness, and fixed or dilated pupils.
Metabolic syndrome.Blood pressure that exceeds 135/85 mm Hg is one of the conditions associated with metabolic syndrome (previously called syndrome X). Other conditions that define this syndrome are obesity, abnormal cholesterol level, and high blood insulin level. Individuals with this combination of risk factors are at a significantly greater risk for developing heart disease, stroke, peripheral vascular disease, and type 2 diabetes. Factors contributing to these conditions include physical inactivity, excessive weight gain, and genetic predisposition.
Myocardial infarction (MI).MI is a life-threatening disorder that may cause high or low blood pressure. Common findings include crushing chest pain that may radiate to the jaw, shoulder, arm, or epigastrium. Other findings include dyspnea, anxiety, nausea, vomiting, weakness, diaphoresis, atrial gallop, and murmurs.
Pheochromocytoma.Paroxysmal or sustained elevated blood pressure characterizes pheochromocytoma and may be accompanied by orthostatic hypotension. Associated signs and symptoms include anxiety, diaphoresis, palpitations, tremors, pallor, nausea, weight loss, and headache.
Polycystic kidney disease.With polycystic kidney disease, elevated blood pressure is typically preceded by flank pain. Other signs and symptoms include enlarged kidneys; an enlarged, tender liver; and intermittent gross hematuria.
Preeclampsia and eclampsia.Potentially life-threatening to the mother and fetus, preeclampsia and eclampsia characteristically increase blood pressure. They're defined as a reading of 140/90 mm Hg or more in the first trimester, a reading of 130/80 mm Hg or more in the second or third trimester, an increase of 30 mm Hg above the patient's baseline systolic pressure, or an increase of 15 mm Hg above the patient's baseline diastolic pressure. Accompanying elevated blood pressure are generalized edema, sudden weight gain of 3 lb (1.4 kg) or more per week during the second or third trimester, severe frontal headache, blurred or double vision, decreased urine output, proteinuria, midabdominal pain, neuromuscular irritability, nausea and, possibly, seizures.
Renovascular stenosis.Renovascular stenosis produces abruptly elevated systolic and diastolic pressures. Other characteristic signs and symptoms include bruits over the upper abdomen or in the costovertebral angles, hematuria, and acute flank pain.
Thyrotoxicosis.Accompanying the elevated systolic pressure associated with thyrotoxicosis, a potentially life-threatening disorder, are widened pulse pressure, tachycardia, bounding pulse, pulsations in the capillary nail beds, palpitations, weight loss, exophthalmos, an enlarged thyroid gland, weakness, diarrhea, a fever over 100° F (37.8° C), and warm, moist skin. The patient may appear nervous and emotionally unstable, displaying occasional outbursts or even psychotic behavior. Heat intolerance, exertional dyspnea and, in females, decreased or absent menses may also occur.
Other causes
Drugs.Central nervous system stimulants (such as amphetamines), sympathomimetics, corticosteroids, nonsteroidal anti-inflammatory drugs, hormonal contraceptives, monoamine oxidase inhibitors, and over-the-counter cold remedies can increase blood pressure, as can cocaine abuse.
Treatments.Kidney dialysis and transplantation cause transient elevated blood pressure.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Rituxan is a monoclonal antibody therapy that was approved several years ago for specific types of non-Hodgkin's lymphoma . At the 2001 American...
In recent years, the drug Rituxan has become a well-established option only for certain forms of non-Hodgkin's lymphoma (NHL) There are other...
Chronic myeloid leukemia (CML) is a cancer of certain white blood cells. However, CML can also affect red blood cells and clotting cells called...
Doctors understand what goes wrong in CML more than they do in most other cancers. Learn what happens in the genes of white blood cells to cause CML.
See full list of 5 related videos
» Next page: Risk Factors for Blood conditions
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
