Blood Pressure Differences Between Arms

ncw3642 · Aug 13, 2024

Hi all,

28M currently 6-weeks post mechanical valve replacement (On-X), aortic aneurysm repair and left main coronary unroofing.

Uneventful postoperative course, had first day of cardiac rehab today. When manually taking my blood pressure, there was a difference on average of 20-25 systolic between arms (117 on left versus 138 on right) and between nurses taking it.

Just checking to see if anyone else has experienced this postoperatively. I wonder if it has something to do with the left coronary unroofing or if it’s just my heart healing. For reference my calcium CT scan was 0 preop, so I don’t think it’s an occlusion.

Any ideas/thoughts?

Edit; should add, just had my CT w/ contrast of chest and head and neck done last week. All was normal postoperative changes and didn’t seem to have any abnormalities.

Chuck C · Aug 13, 2024

Hi.

I had a ST Jude mechanical aortic valve installed about 3.5 years ago. I do take my blood pressure at home every few weeks, but always just use my left arm. After reading your post, I thought I would check the right arm against my left arm and see where things are at for me.

Left arm: 119/77
Right arm: 122/75

So, essentially mine are the same.

BTW, I use the Welch Allyn blood pressure device to check mine. After my surgery, they sent me home with one for two weeks and I was instructed to take my BP every day and report it to them. I had to return it, but I was so impressed that I bought one for myself. It was about $90

tommyboy14 · Aug 13, 2024

When I was going for my second surgery, my cardiologist performed this test on me. He checked the left and right arm blood pressure and said that this is a sign of that the LV is dilating and that the valve needs changing again. He was right. He explained to me that this was an old school way of testing for heart issues.

I suspect that with only 6 weeks past surgery, but heart remodelling post surgery taking up to a year, you probably are still showing pre-surgery symptoms.

Hang in there, it should get better.

pellicle · Aug 13, 2024

tommyboy14 said:
He checked the left and right arm blood pressure and said that this is a sign of that the LV is dilating and that the valve needs changing again. He was right. He explained to me that this was an old school way of testing for heart issues.

well, now *that* was interesting. I haven't had someone check my left and right arm with a stethoscope since I was a kid.

So much useful indirect sources available from the past; but of course the modern imaging and electro-investigations are far superior to that. (few seem to know how to use a stethoscope now anyway.

PS: years ago I asked and was told its because the veins are stronger in the right arm because that's the primary arm; its bigger and stronger. I mentioned I was left handed in all sports (like Tennis and Squash) and got a blank look. To this day my left wrist is bigger than my right (swaps watch between sides now and then, so I sort of measure it a bit).

ncw3642 · Aug 13, 2024

tommyboy14 said:
When I was going for my second surgery, my cardiologist performed this test on me. He checked the left and right arm blood pressure and said that this is a sign of that the LV is dilating and that the valve needs changing again. He was right. He explained to me that this was an old school way of testing for heart issues.

I suspect that with only 6 weeks past surgery, but heart remodelling post surgery taking up to a year, you probably are still showing pre-surgery symptoms.

Hang in there, it should get better.

Thank you for your response!

Do you think the same applies if my LV was normal on my echo prior to my surgery? They didn’t take a postoperative echo (just a CT w/ contrast so I have no comparison for a while until it’s ordered in a few months) but the one taken a month prior to surgery said..

CONCLUSIONS: 1. Low normal global left ventricular systolic function. Ejection Fraction is estimated at 50-55 %. Normal left ventricular diastolic function. Normal left ventricular cavity size. LV wall thickness is within normal limits.

2. Normal right ventricular systolic function. Normal right ventricular size.

3. Probable bicuspid AV. There is probably adequate aortic valve cusp separation.

There is no aortic stenosis. Mild to moderate, eccentric aortic valve regurgitation.

d333gs · Aug 14, 2024

Chuck C said:
Hi.

I had a ST Jude mechanical aortic valve installed about 3.5 years ago. I do take my blood pressure at home every few weeks, but always just use my left arm. After reading your post, I thought I would check the right arm against my left arm and see where things are at for me.

Left arm: 119/77
Right arm: 122/75

So, essentially mine are the same.

BTW, I use the Welch Allyn blood pressure device to check mine. After my surgery, they sent me home with one for two weeks and I was instructed to take my BP every day and report it to them. I had to return it, but I was so impressed that I bought one for myself. It was about $90

Good numbers

ncw3642 · Aug 14, 2024

Per the nurse at my Surgeon's office:
"Blood pressure differences are often normal. Your CT scan looked great yesterday and no indication for worry over blood pressure differences. Should continue to follow.”

Still not sure the 15-25 point difference is normal, but maybe it will resolve over time?

carolinemc · Aug 14, 2024

ncw3642 said:
Hi all,

28M currently 6-weeks post mechanical valve replacement (On-X), aortic aneurysm repair and left main coronary unroofing.

Uneventful postoperative course, had first day of cardiac rehab today. When manually taking my blood pressure, there was a difference on average of 20-25 systolic between arms (117 on left versus 138 on right) and between nurses taking it.

Just checking to see if anyone else has experienced this postoperatively. I wonder if it has something to do with the left coronary unroofing or if it’s just my heart healing. For reference my calcium CT scan was 0 preop, so I don’t think it’s an occlusion.

Any ideas/thoughts?

Edit; should add, just had my CT w/ contrast of chest and head and neck done last week. All was normal postoperative changes and didn’t seem to have any abnormalities.

I experience this due to the fact, some nurses have not been trained to let the patient get to the room, rest for 5 minutes and then take the BP on each arm. And there can be a slight difference between them. Not unusual at all. And what was the /? for your BP is 117/??, and 138/??

ncw3642 · Aug 14, 2024

carolinemc said:
I experience this due to the fact, some nurses have not been trained to let the patient get to the room, rest for 5 minutes and then take the BP on each arm. And there can be a slight difference between them. Not unusual at all. And what was the /? for your BP is 117/??, and 138/??

Hi!
Didn't include the diastolic because it was unremarkable between the readings and normal. I believe it was both 117/74 and 138/76.

I would agree with you there- I notice that a lot too! In this case, it was taken at two different times on both arms with multiple attempts and there was a consistently higher reading on my R arm than my L arm. Strange finding, but if there is no known vascular reason based on my chest CT recently, not sure it warrants worrying about it.

3mm · Aug 14, 2024

Nice article from Mayo clinic
https://www.mayoclinic.org/diseases...re/expert-answers/blood-pressure/faq-20058230

ncw3642 · Aug 14, 2024

3mm said:
Nice article from Mayo clinic
https://www.mayoclinic.org/diseases...re/expert-answers/blood-pressure/faq-20058230

Thank you for that article!

I am actually familiar with the implications for differences in blood pressure between arms. I actually treat a lot of patients on the cardiac floor who have this issue but usually in the setting of peripheral artery disease.

I was more just wondering if anyone has anecdotal experience with blood pressure differences L to R after OHS as my CT of my chest as well as my heart calcium score was negative/zero for any abnormalities as of a few days ago.

Just looking for answers when the answer might as well be "unsure, but no issues."

tjay · Aug 15, 2024

I’ve taken my blood pressure on both arms for years, and it’s been 10 point difference between the two arms, even now after the surgery 3 weeks later.

Left arm is lower than the right.

I generally take right arm first. Then left.

Often time I take left arm first and the difference is smaller. Try switching which arm goes first and see if that reduces the differential.

Change the battery on the monitor. Buy a different monitor. Sit ergonomically right while taking reading. Buy the correct cuff size if you’re a little muscular at biceps. Regular cuffs are too small. Sometimes dominating arms are bigger. Remove all variables. Larger data set will identify the outlier if any. Measurement error are a classic engineering problem.

Since your aorta etc is now fixed up, this may just be uninteresting find. But find out more.

pellicle · Aug 15, 2024

3mm said:
Nice article from Mayo clinic
https://www.mayoclinic.org/diseases...re/expert-answers/blood-pressure/faq-20058230

interesting; from that (my annotated for reference):

A repeated difference of more than 10 mm Hg in blood pressure measurement between the arms can be a sign of a health problem such as:

Blocked arteries in the arms, known as peripheral artery disease.
Diabetes.
Kidney disease.
Heart problem.

If you have a large difference in blood pressure readings between arms, talk to your health care provider. Your provider might use the arm with the higher reading to measure your blood pressure in the future.

so the "can be" will (I would hope) for most of us here resolved by more specific diagnostic tools (such as CT scans and Echos) which will properly address "Heart problem".

Beyond that while its an intersting thing

pellicle · Aug 15, 2024

so, I thought I'd search

Inter-arm blood pressure difference as a tool for predicting coronary artery disease severityhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379529/

Conclusion

The differences in BP between the arms were found to be having a strong positive correlation with CAD severity.

which is interesting because to my knowledge there is no correlation between coronary artery obstruction and Left Ventricle Hypertrophy (anyone?)

This article (pdf link) suggests to me that the connection is sketchy but warrants doing because its simple

CONCLUSION

In general, it is more common practice today to take blood pressure in one arm. In this scenario, there is a chance that the alterations, which are suggestive of any underlying vascular disorders, may go unnoticed, increasing the likelihood of a missed diagnosis of HTN and inappropriate care, which carries a danger to cardiovascular health. Since measuring BP is a straightforward yet crucial factor in identifying the group of people who are most likely to have vascular events in the future, especially in HTN patients who appear to be under control, Studies are required to establish the incidence of IAD in the study area's adult population.

So to me the bottom line is "its a worthwhile indicator for screening someone who is otherwise not symptomatic and may warrant being used as a guide.

Since people are averse to "high false positive" tests I'd suggest more research is needed to validate this (or at least a better literature review than I've undertaken here as someone may have already done that "more research"

Best wishes

Timmay · Aug 15, 2024

Right handed.

Right arm: 121/79
Left arm: 125/78

This is after being awake for 4 hours … 2 cups of coffee and a full breakfast at a local diner (not normal for me but my son is in town).

I’m on Amlodipine Besylate, 5mg. I am currently NOT on Metoprolol, but, for the record, when I have taken it my BP gets reduced by another 10 on both the upper and lower reading.

perrybucsdad · Aug 15, 2024

I know I have differences between my left and right arms, but I was told that it has to do with the Coart repair from my younger days, not from my valve. I never fully understood this as I thought the arteries to both arms come off the aorta normally before where a Coart happens (brachiocephalic trunk for left arm and one of the subclavian arteries for the right.... but I could be wrong).

carolinemc · Aug 17, 2024

ncw3642 said:
Hi!
Didn't include the diastolic because it was unremarkable between the readings and normal. I believe it was both 117/74 and 138/76.

I would agree with you there- I notice that a lot too! In this case, it was taken at two different times on both arms with multiple attempts and there was a consistently higher reading on my R arm than my L arm. Strange finding, but if there is no known vascular reason based on my chest CT recently, not sure it warrants worrying about it.

I had issues back when I was 10 years old, and the nurse did it on both arms. It was new on kids back in the 1980's. Things they learned way back on us kids.

Windfinder · Aug 29, 2024

Hi, I had for the last 16 years a blood pressure difference of approx 50 mmHg between left arm and right arm. Most times my left was 115/60 and my right arm was 165/60, I had aortic regurgitation and stenosis but they said that couldn’t be the reason. I have worried about it for years and nobody, even the best doctors and cardiologist in different countries was able to give me an explanation. Looking online I found similar info to what Pellicle has posted, which got me worried.
Finally, about 5 weeks ago I had AVR and now my difference is only 15 mmHg and sometimes just 10…so go figure…my surgeon said he didn’t think the surgery would make a difference but it did. He was never worried about it, even though I was….

pellicle · Aug 29, 2024

Windfinder said:
Hi, I had for the last 16 years a blood pressure difference of approx 50 mmHg between left arm and right arm. Most times my left was 115/60 and my right arm was 165/60

wow

like that's huge

Finally, about 5 weeks ago I had AVR and now my difference is only 15 mmHg and sometimes just 10…so go figure…my surgeon said he didn’t think the surgery would make a difference but it did.

and now that its dropped to only 15mm (something over 3 times less) your surgeon still isn't seeing any relationship.

So this

I had aortic regurgitation and stenosis but they said that couldn’t be the reason.

leads me to ask: how long do you think you had stenosis for?

Windfinder · Aug 30, 2024

The stenosis started just about three years after the valve sparing, like in 2011, but mild at first ( 20 mmhg) ….my original problem was just severe regurgitation due to BAV…something curious happened, there was a relatively long period ( I would say about 10 years) where the thickening of the flaps due calcium build up that came cause the stenosis made the regurgitation a bit better. That’s the reason they gave me for how long I was able to hang in there without the redo surgery. Finally the last few years stenosis just got too bad, mean gradient of 88 and we decided to do the AVR even though I could still exercise at decent levels…but wanted to prevent heart muscle damage since it was already slightly enlarged…

Blood Pressure Differences Between Arms

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