Narrowing of pulse pressure when standing, what is it called?

[JuliaMaple]

Hey there everyone,
I was wondering what the following (below) should be called. I think its not POTS, does not look like orthostatic hypotension, but what is it? I sort of have POTS/orthostatic intollerance as a diagnosis right now, but its not a set one yet as the doctor does not know for sure. I am trying to discover more about what exactly happens when I stand and found out the following.

Below there is a series of blood pressure measurements that I did, while doing a poor mans tilt table test at home. I use a blood pressure meter with an arm cuff (Omron m6 comfort). And I measure while standing upright, with my arm just hanging down.
I have done this test over and over again through time, and 'every time' my pulse pressure narrows to 11/12, which is when I start to faint.

12:22 - 99/63 73 (pulse pressure 36)
12:23 - 97/61 71 (pulse pressure 36)
12:26 - 97/78 99 (pulse pressure 19)
12:28 - 98/82 102 (pulse pressure 16)
12:30 - 99/80 94 (pulse pressure 19)
12:31 - 105/92 103 (pulse pressure 13)
12:33 - 91/80 106 (pulse pressure 11)
When I stop (which I have to), often there will be a really sudden drop, which makes me faint if I am not careful. This one went to 71/34 suddenly. I was pretty much gone but did manage to lay down instead of falling.
When I am down on the floor, it all rises towards 120/65 HR45 (pulse pressure 55)
So blood pressure recovers right away, but my brain remains dead (or well.. not quite but the rest of the day will be a blurry event).

So, my blood pressure, does not drop that much, my heart rate does not rise 'that much', but the pulse pressure narrows, and it stays that way, until I fall down. I think 'that' is my problem. That is not POTS right? Or is it? And if its not, what is it called?
Moving about influences the speed of the drop, when I keep moving my legs, my pulse pressure will not drop nearly as fast, but my brain becomes blurry anyway.
And, I have measured saturation a couple of times too. It tends to be really high (99) at first, and when I am doing the standing there will be spikes down between 90 an 80.

Thanks in advance for any input/ideas.

 

[Valentijn]

So, my blood pressure, does not drop that much, my heart rate does not rise 'that much', but the pulse pressure narrows, and it stays that way, until I fall down. I think 'that' is my problem. That is not POTS right? Or is it? And if its not, what is it called?

It's not POTS. It might fit as Neurally Mediated Hypotension.

 

[JuliaMaple]

@Valentijn I will google that a bit more then, thanks for your idea
The confusing bit is that my body sometimes does behave POTS like, sometimes blood pressure and heart rate both rise when I stand up, or sit up.
But I also have days where both my heart rate and blood pressure go low at the same time for hours. The heart rate goes as low as 40 sometimes, and blood pressure stays low then as well. That is when I fall asleep during the day. I often try to drink lots of coffee to counter that, to get one (or both) up, so that I can fight the sleepiness. (also lots of water and saltiness)

Right now I have another version, I have a high resting heart rate for some days already (around 90), and my BP is normal-ish at the moment, except for the narrowing of pulse pressure when I stand. At night I sometimes wake up because my heart is pounding and stressed out.

Its a bit difficult to know which thread to follow, nothing stays the same. Its as if there is not '1' specific problem, it sways and changes. Its a couple of days (or weeks) of this, and then a couple of days of that, and so on. When I think I have figured something out, it changes again after a while, leaving me confused because it does not fit.
The only thing that I have seen coming back again and again is narrow pulse pressure if I stand too long, even when BP is high, pulse pressure can be narrow. Like a week or so ago it was 125/112 once, after walking the stairs (125 is high for me, and 112 obviously is not low : p either). High pressure does not happen a lot, but apparently when it does, pulse pressure can still be low.

Its not all the time, pulse pressure can also be wide after walking the stairs, and when I sit or lay down its always wide. I cannot really figure it out. Hopefully the doctor can.
I was hoping someone here would recognize the pulse pressure problem. I will show this list to my doctor when I see him again. I have taken pictures of the BP machine, throughout the whole standing test. So that he can see it.

 

[Valentijn]

The confusing bit is that my body sometimes does behave POTS like, sometimes blood pressure and heart rate both rise when I stand up, or sit up.

Yes, the narrow pulse pressure can trigger tachycardia as a coping mechanism - sometimes. But labeling it as POTS even in those circumstances would be misleading and unhelpful. If the cause of tachycardia is narrow pulse pressure, then POTS drugs which reduce heart rate would be an extremely bad idea, for example.

I was hoping someone here would recognize the pulse pressure problem.

A lot of us have narrow pulse pressure, myself included. It's only a minority of ME patients that have true POTS as their form of Orthostatic Intolerance. Most have NMH, according to research by Rowe.

The tricky part is that there is very little focus on pulse pressure, so it's not completely clear if NMH explicitly includes narrow pulse pressure, in addition to low blood pressure. But NMH seems like the closest description for it.

 

[Gingergrrl]

A lot of us have narrow pulse pressure, myself included. It's only a minority of ME patients that have true POTS as their form of Orthostatic Intolerance.

Thanks and that is interesting. I have POTS 100% as confirmed by more than one Tilt Table Test but I also have a very narrow pulse pressure, even when seated. I've frequently seen my PP around 16-18 but my normal PP is between 25-30. It would be extremely rare for me to ever have a PP over 30 (regardless of POTS symptoms). Does this have a name other than being part of general autonomic dysfunction?

 

[Valentijn]

Does this have a name other than being part of general autonomic dysfunction?

The only detailed scientific/medical information I've seen regarding narrow pulse pressure is in the context of losing a lot of blood from major trauma like a car crash. In that case, 25 and under is a medical emergency - though obviously not for us, since we're at 25 and under on a daily basis without it being fatal.

I haven't seen anything regarding chronic low pulse pressure. But it's been a while since I looked, so maybe there's something new out there.

 

[Sushi]

I haven't seen anything regarding chronic low pulse pressure. But it's been a while since I looked, so maybe there's something new out there.

My autonomic specialist regarded pulse pressure below 18 as diagnostic for dysautonomia. I'd guess that the discussions around this that are relevant to us happen mostly in disautonomia circles.

 

[denmarkk]

Narrow Pulse Pressure can be caused by low stroke volume. Usually it is viewed as a possible symptom of cardiac disease. BUT, in ME and CFS cases it may simply be from heart muscle fatigue. As our cardiac muscle cells run out of energy, they can't pump with as much force needed to meet the demand of circulating blood while standing. Our hearts can't handle the extra workload of fighting gravity when standing. When we move our legs it's easier on the heart because our leg muscles help with returning the blood to the heart. Your pulse rate is increasing to compensate.

Usually the recommendation is to take in extra salt and fluid, so that the body will increase its blood volume.

 

[Alisha12]

Hey there everyone,
I was wondering what the following (below) should be called. I think its not POTS, does not look like orthostatic hypotension, but what is it? I sort of have POTS/orthostatic intollerance as a diagnosis right now, but its not a set one yet as the doctor does not know for sure. I am trying to discover more about what exactly happens when I stand and found out the following.

Below there is a series of blood pressure measurements that I did, while doing a poor mans tilt table test at home. I use a blood pressure meter with an arm cuff (Omron m6 comfort). And I measure while standing upright, with my arm just hanging down.
I have done this test over and over again through time, and 'every time' my pulse pressure narrows to 11/12, which is when I start to faint.

12:22 - 99/63 73 (pulse pressure 36)
12:23 - 97/61 71 (pulse pressure 36)
12:26 - 97/78 99 (pulse pressure 19)
12:28 - 98/82 102 (pulse pressure 16)
12:30 - 99/80 94 (pulse pressure 19)
12:31 - 105/92 103 (pulse pressure 13)
12:33 - 91/80 106 (pulse pressure 11)
When I stop (which I have to), often there will be a really sudden drop, which makes me faint if I am not careful. This one went to 71/34 suddenly. I was pretty much gone but did manage to lay down instead of falling.
When I am down on the floor, it all rises towards 120/65 HR45 (pulse pressure 55)
So blood pressure recovers right away, but my brain remains dead (or well.. not quite but the rest of the day will be a blurry event).

So, my blood pressure, does not drop that much, my heart rate does not rise 'that much', but the pulse pressure narrows, and it stays that way, until I fall down. I think 'that' is my problem. That is not POTS right? Or is it? And if its not, what is it called?
Moving about influences the speed of the drop, when I keep moving my legs, my pulse pressure will not drop nearly as fast, but my brain becomes blurry anyway.
And, I have measured saturation a couple of times too. It tends to be really high (99) at first, and when I am doing the standing there will be spikes down between 90 an 80.

Thanks in advance for any input/ideas.

Hi. .this low pulse pressure is one of the types or mechanism of orthostatic intolerance. Please search for Dr Bell's article for OI which right now I'm unable to link here.But it gives really amazing description of OI.

 

[ramakentesh]

Outside a cardiac origin there are only two reasons someone would have a narrowing pulse pressure on standing (something I also get when symptomatic) - reduced venous return or hypovolemia (either absolute or from shocklike leakage of plasma into surrounding tissue).
In some ways this is a great thing because it can be addressed by either increasing volume status - ultra hydration, florinef or desmo or by improving venous return to minimise symptoms via midodrine, phenylephrine, pseudoephedrine or similar pressors.
Its possible that veins alone are the problem here. sympathetic innervation, etc.