Anyone heard of Diastolic BP being higher than Systolic???

[WSU_Ally_RN]

I have a cousin that was talking with her mom today and was insisting her BP was 130's/150's. I told her that was impossible, I have never encountered that, nor heard of that, but she kept insisting that was correct. She even said that's how it was in her MD's office today... Has anyone here ever seen a diastolic larger than a systolic??? Or is my cousin slightly confused over her bp reading...

[DA314]

Pretty sure this is impossible. I think your cousin is confused, or the nurse at her MDs office charted it wrong

[P_RN, ADN, RN]

I don't even trust an automatic machine when *I* do it. The only real BP I trust is one with a manual cuff and a steth done by someone *I* trust or if *I* do it myself.

This situation is impossible. The resting heart cannot exert pressure (diastolic) higher than the working heart exerts (systolic). One thing they may be confusing is the 3rd Korsakoff sound that sometimes is heard below the diastolic if the taker continues to listen to zero.

[DaveCRNA]

Just my own thoughts here...

in order for the Aortic valve to open, the heart must pump. The heart must pump hard enough to overcome the systemic resistance aka afterload...aka diastolic blood pressure. As the ventricles pump, pressure increases within the heart until the pressure exceeds the systemic (diastolic) pressures, when it surpasses this pressure the aortic valve opens allowing the blood to be pumped from the heart.

So in order to circulate blood the systolic pressure MUST exceed diastolic pressure.

I really can't imagine any way for diastolic pressures to be higher than systolic. I have seen instances with certain types of devices: LVADs, ECMO etc.. where these pressures were the same because of a lack of pulsatility with these types of pumps. But still they are equal or we only see a mean pressure.

These observations are from an arterial catheter.

my

[cherrybreeze, ADN, RN]

Did the person taking the BP put the cuff on upside down?

Kidding.

[DaveCRNA]

Even though speed and pressure are NOT the same, maybe you could point out that you can't be driving (working) your car at 45mph and then come to a complete stop (rest) at 65mph.

Again, not the same, yet perhaps it could help someone who doesn't "get it" visualize why it is so absurd.

I just was thinking to myself, how I could explain this to someone who just doesn't know in the simplest way... maybe it's a bad analogy? What do you think?

A very nice analogy.

[TurismoDreamin]

NCLEX question: As a nurse, my initial response to this woman would be: (A) Assess the patient for mental retardation (B) Assess the patient for dyslexia © Both A and B (D) Neither A nor B

[CaliGirl0629]

Only time I've heard this can happen was with an IABP.

[Magsulfate, BSN, RN]

no, if you're cousin was living in a fairy tale world and her bp was really like that, then the diastolic would be the systolic... see? The higher pressure IS THE HEART'S pressure at maximum stress..... so if in this fairy tale land, her diastolic reached higher than her systolic , technically the 'bottom' number would be the systolic and she's have it BACKWARDS!! lol.

[motion+e]

That depends on what you are asking...do I believe that your cousin's reading was correct?...no. Is it possible that the diastolic could be higher than the systolic that supplied it?...yes...and this temporary backward spike may be more common than what we realize. First you have to understand fluid dynamics...that is that fluids can not or nearly can not be compressed...when I say nearly...it takes a great amount of pressure to compress a fluid the tiniest bit...more pressure than we would ever see in the human body...so we will just stick with it being non-compressible in the medical field.

The fact that a diastolic reading indicates a pressure at all is saying that there is a "holding" pressure and this holding pressure could increase if something were to exert a force on it...like the constriction of a vessel...we would not visually be able to see the constriction at this precise moment for it can not compress the blood but yet there is energy being exerted onto the blood supply via the vessel...thus causing an increase in pressure...which in turn could raise above the previous systolic pressure until the valves of the heart open...allowing the vessel to constrict...which we could now see visually etc.

So this actually brings me to another side of this topic...the fact that we are taught that resistance is what causes BP...this is ludicrous...the vascular system is a closed system...meaning that pressure will be equal throughout the body...resistance can cause a back pressure in an open system...but a closed system...nada. Certainly there is resistance...adhesion of molecules...etc...but this is not enough to regulate pressure...it deals more with flow rate than it does actual pressure. Energy exerted on spacial volume change is what would increase or decrease pressure...meaning that adrenaline and noradrenaline regulate pressure for the most part by constricting and dilating vessel diameters. If it were resistance that determined pressure, we would see irregular pressures and flow rates through the entire body...meaning a drop in pressure when the diameter of a vessel goes from small to larger...etc...blood flow return would be erratic in volume and pressure...it just is not feasible...so quit using the term resistance for BP...it is simple principles of displacement. :)

[Guest219794]

I would tell your cousin that this is a serious situation which she needs to deal with.

She needs a well balanced diet, 8 hrs sleep every night, and an average of 1 hour excersize every day.

After doing this for six months, she shuold go have her blood pressure checked.

I guarrantee her diastolic will be lower than her systolic, and she will feel great.

[regularRN]

Maybe it was 130/50?

[jlcole45]

It's impossible! Use your head and think about it. If that were the case then the blood would not circulate at all.