Diastolic BP of zero

[littlehobo]

Strange question here. I was doing a manual blood pressure on a patient today and got the Systolic fine, but could still hear the korkotoff (spelling??) sound even when the cuff was deflated giving a diastolic of zero. I tried this twice and got the same result, although I couldn't hear it if I just placed the stephoscope on the arm without doing a BP first.

This only happened in the left arm and not the right. I mentioned it to one of the doctors and clinical matron, both of whom said it was something they had heard of, but couldn't remember the reasons why, but was nothing to worry about.

Anyone heard of anything similar or can shed any light!!!

Ta

Bruce

[Indy, LPN, LVN]

Never heard of that. What did you get in the other arm?

[mandana]

If cardiac output is high, K sounds can be heard until zero. In these cases, it is best to read BP when the sounds first muffle. This can be a fairly subjective thing.

I'm surprised that they told you not to worry about it, several pathological states can cause increased cardiac output. Having said that, it's quite normal to hear sounds until zero in children.

What was the person being seen for? I'm curious now. Age group of patient?

[jimthorp]

I have a resident that this is the case. When determining the diastolic pressure I listen for when the sound changes to a less crisp sound. This change may be very subtle at times.

[MIA-RN1, RN]

I work w/ kids ages 11 - 19 and I was taught by the NP to pay attention to the muffle and use that last 'normal' sound if the sounds don't go away as expected.

[P_RN, ADN, RN]

I've had that with very old people with hard arteries. Sometimes you can kind of do a combined steth and manual bp and when the feel and the sound change that the diastole I choose. (you can put a comment of muffled or difficult to hear.)

[MMARN, BSN, RN]

Awww, man!!!!! I hope I don't get something like that in nursing school. I'm having trouble as it is with the "normal" sounds!!!!!

[DutchgirlRN, ASN, RN]

I have a resident that this is the case. When determining the diastolic pressure I listen for when the sound changes to a less crisp sound. This change may be very subtle at times.

:yeahthat:

[littlehobo]

Hi,

The guy was about 70 years old, with no cardiac hx. BP in the right arm was 115/40, which was consistent with all other readings. As far as I can remember he was in for poorly controlled diabetes and a Pneumonia.

I agree it does seem strange that they thought it was nothing to worry about, the only other time I seen this kind of thing mentioned (on the internet) was in pregnant women! Didn't say why though!

Don't think it could have been a high Cardiac output, because systolic was fairly low, and it was only in one arm.

[jimthorp]

Hi,

The guy was about 70 years old, with no cardiac hx. BP in the right arm was 115/40, which was consistent with all other readings. As far as I can remember he was in for poorly controlled diabetes and a Pneumonia.

I agree it does seem strange that they thought it was nothing to worry about, the only other time I seen this kind of thing mentioned (on the internet) was in pregnant women! Didn't say why though!

Don't think it could have been a high Cardiac output, because systolic was fairly low, and it was only in one arm.

A high CO does not neccessarily mean a high systolic pressure.

Remember, CO = HR x stroke volume.

[littlehobo]

A high CO does not neccessarily mean a high systolic pressure.

HR was about 80 BPM if that makes a difference...?

[Zee_RN, BSN, RN]

Heck, that frequently happens to me and has for years. When I was in nursing school and we used to take BPs on each other for practice, I always confused my fellow students because my BP "bumps all the way down." My BP tends to run lower anyway (SBP 100). My doctor just told me "you'll live forever."