What causes very low blood pressure?

Thanks for an interesting question. First, I should define a normal blood pressure.
Blood pressure is measured in millimeters of mercury. The first or upper number is known as the systolic blood pressure. It is the pressure that occurs in the arteries when the heart muscle contracts and pumps blood.

A normal systolic is 120 or less. Blood pressure of 120 to 140 is considered pre-hypertensive. A systolic over 140 is considered hypertensive.

The diastolic is the second or lower number. It is the pressure in the arteries when the heart relaxes and fills with blood. A diastolic of less than 90 is considered normal.

If you are using an automatic blood pressure cuff, it may be reading the diastolic lower than it actually is. This is often a problem if the blood pressure cuff is too big or too small for your arm.

Low blood pressure is only a concern when a patient has symptoms such as being lightheaded, a change in vision, losing consciousness, shortness of breath, or poor exercise tolerance. Patients most commonly complain of these symptoms when standing up from a sitting position or sitting up after lying down for awhile. This is called orthostatic hypotension and usually lasts only a short time. Patients with these symptoms need to seek medical attention.

Hypotension (low blood pressure) is most commonly caused by medications. Blood pressure medications, antidepressants and other drugs can impair the nerves of blood vessels in the legs. Normally these nerves make blood vessels in the leg contract when one is rising. When the blood vessels do not contract when changing position, blood is pooled in the legs. This deprives some blood volume from the heart, and the symptoms occur due to decreased blood perfusion of the brain.

Some patients have symptomatic low blood pressure due to a low amount of fluid in their body. This is called hypovolemia. It can be due to dehydration, caused by sweating from exercise, decreased oral intake, or use of a diuretic. Diuretics are commonly used to treat high blood pressure, but one of the most common diuretics that people encounter is caffeine.

Uncommon reasons for a low blood pressure include problems of the heart. One way that most people's bodies deal with a small amount of dehydration is to increase the heart rate, but some patients have a heart problem that does not allow them to increase their heart rate. This is often treated with a pacemaker.

Congestive heart failure is often associated with high blood pressure but can also be associated with symptomatic low blood pressure. New onset congestive heart failure is an emergency.

Very rarely, the cause of the symptomatic low blood pressure cannot be determined. There are some drug therapies that are used in these cases. Increased salt intake is often a simple solution.

Low blood pressure without any symptoms merits a medical evaluation, but rarely needs to be treated.

Conditions Expert 
Dr. Otis Brawley Chief Medical Officer,
American Cancer Society 

Technology advances ease personal diabetes care

Insulin pumps, patch pumps, continuous glucose monitors can help you manage diabetes.

Insulin pumps, insulin pens and blood sugar monitors. Those are some of the latest devices that can make it easier for the millions of people with diabetes to manage the disease.

But even as new technologies take hold — and even more are on the horizon — it means patients need to be smart, educated consumers to choose the device that works for them.

“There has been an explosion of available medications, technologies and glucose-health tracking tools available for people living with diabetes. It is therefore important that consumers be mindful and research what is available and ensure that all major diabetes management decisions are discussed with the individual’s health care team,” said Kellie Rodriguez, director of education services at the Diabetes Research Institute, University of Miami.


Another resource, offered by the American Diabetes Association: an annual consumers guide.

No matter the technology, consulting with a certified diabetes educator and training is crucial, said Lois Exelbert, a board member for the local American Diabetes Association and director of the diabetes center at Baptist Hospital.

“Somebody who goes on a pump without the proper education risks dangerous consequences,” she said. “They can have a kink in the pump and not know it, or they can miscalculate a dose if they are not properly informed.”

With that caveat, here are some options to review with your doctor and diabetes educator.

INSULIN PUMPS

New ‘smart’ pumps form the cornerstone of technological advancement, Rodriguez said. They provide the closest tool to replicate how our bodies deliver insulin. There are currently four on the market:
•  Omnipod by Insulet;
•  One Touch Ping by Animas / Johnson & Johnson;
•  Revel by Medtronic; and
•  Spirit by Roche.

All have similar options to deliver insulin: calculators, the ability to vary the amount of basal, or baseline, insulin, and delayed injections. Some have additional features. For example, the Omnipod offers a tubeless pump; the One Touch Ping has a remote insulin calculation and delivery and personalized food diary; and the Revel combines the pump with continuous glucose monitor capabilities.

In the future, there could be pumps that automatically shut off if someone has hypoglycemia, Rodriguez said. The ultimate goal: incorporate a patch pump to detect glucose and respond to changes — independent of the patient.

For Astrid Matthysse, who uses the One Touch Ping, the elimination of injections wasn’t the most important change. “Just the freedom I have with the pump — an easier lifestyle,” she said. Matthysse, 51 and the mom of two college kids, keeps a busy schedule. She works as a clinical manager for Animas and is earning a master’s degree in international business.

“When I was on injections, I had to stop to eat, otherwise my blood sugar would drop too low. Now with the pump, I can eat whenever I want and my blood sugar will not be affected,” she said.

PATCH PUMPS

These offer another method to deliver insulin. They have an insulin reservoir, delivery system and cannula — an insertion device — all built into a small, wearable device that is disposable or semi disposable.

“Patch pumps simplify traditional insulin pump therapy — essentially they are tube-free pumps,” Rodriguez said. Insulet’s Omnipod is available in the United States. A new patch is on the horizon for 2012: the V-Go, a fully disposable device to deliver basal and bolus insulin for adults.

Rodriguez said some of the benefits are that they are easier to use because there are no tubes; training is simplified; and the up-front costs are lower.

CONTINUOUS MONITORS

Continuous glucose monitors (CGMs) can give nearly 300 glucose readings in 24 hours; provide trending information, which is especially valuable overnight and after a meal.

Exelbert said continuous monitors are a key instrument for people whose blood sugar fluctuates a lot. Even if not used permanently, Exelbert said the continuous monitor can be used for a week as a diagnostic tool.

The benefit: more blood sugar readings and information if the level is headed down or up, she said. If someone tests their glucose every two hours, “what’s still missing in between is what happens to blood sugar and you don’t know if blood sugar is on the way up or down,” Exelbert said. “But by wearing a continuous glucose monitor you’re getting readings every five minutes and it’s telling you if it’s trending up or down.”

There are four continuous glucose monitor systems available on the market: DexCom; Guardian by Medtronic; I-Pro, and the Paradigm/Revel Insulin Pump sensor combination by Medtronic.

Della Matheson, a registered nurse and research coordinator at the Diabetes Research Institute, University of Miami, said she used to stick her finger eight to 10 times a day. With her continuous sensor — she uses DexCom — she can get a reading every five minutes.

“It gives me more information so I can anticipate where I’m headed and what I’m going to do behaviorally,” she said. “It [sounds an] alarm if you go below or above your target – it’s a hypoglycemia alert system.”

METERS AND PENS

People with diabetes can find both disposable and non-disposable insulin pens. The needles have become smaller and companies have made their own advances. For example, Lilly’s pen, called the Memoire, provides a reminder of when the last bolus of insulin was delivered and how much.

Matheson said the pens are more convenient. “You can carry them in your purse or your pocket, it makes it easier to take your insulin on the go,” she said.

By Laura Isensee
lisensee@MiamiHerald.com

 

Learn About Diabetes Complications: What Diabetes Can Do to Your Body

If not controlled, diabetes can cause a host of complications that can affect nearly every organ in the body. Diabetes complications include:

• Heart disease
• Stroke
• Kidney disease
• Nerve damage
• Eye damage
• Digestion problems
• Erectile dysfunction
• Skin problems
• Infection
• Dental problems

Heart Disease

Heart disease is one of the most common diabetes complications. In office visits, your doctor may perform various tests to check for heart disease and help you prevent any serious heart-related problems. At every visit, your health care provider will check your blood pressure. Your cholesterol level and triglycerides may be checked at your first visit. A baseline EKG should also be obtained as part of a complete medical record. Learn more about personal risk factors you have for heart disease, such as a family history or whether you smoke, and work out a prevention plan that includes weight loss, regular exercise, and stress management, as well as keeping your blood pressure, cholesterol, and triglycerides at normal levels.

Stroke

Signs and symptoms of stroke include sudden weakness on one side of the face or body; numbness in the face, arm, or leg; difficulty speaking; trouble seeing with both eyes; or dizziness. If you have any of these symptoms, see a doctor immediately. You may be referred to a neurologist or other stroke specialist. Read more about the warning signs of stroke and also be aware of ways to prevent this serious problem from happening to you.

Diabetic Nephropathy (Kidney Disease)

If you have diabetes, urine testing should be performed yearly to look for diabetic nephropathy -- kidney disease. A baseline creatinine blood test should also be done to determine your kidney function. Your health care provider will also check your blood pressure regularly since control of high blood pressure is essential in slowing kidney disease. Blood pressure should be less than 130/80. Read about other symptoms of kidney disease in this health topic, such as persistent leg or feet swelling. Find out when to call your doctor to prevent serious problems.

Diabetic Neuropathy (Nerve Damage)

Over time, diabetes can cause nerve damage that produces symptoms of numbness, burning, or pain. If you skin becomes numb, you may not notice small wounds that could grow to become bigger health treats. Check your feet and hands daily for redness, calluses, cracks, or skin breakdown. If you notice any of these symptoms before your next scheduled visit, notify your health care provider immediately.

Diabetic Retinopathy

To protect your vision, all people with diabetes should see an ophthalmologist (an eye doctor) at least yearly. As part of the eye exam the doctor will dilate your eyes so that he or she can see the back of the eye (retina) and determine if the diabetes is causing damage. In people with type 1 diabetes, these annual exams should start within three to five years of diabetes once the patient is aged 10 or older. People with type 2 diabetes should have their first eye exam once they are diagnosed. Those with eye complications may need to see their ophthalmologist more frequently. Women with diabetes who become pregnant should have a comprehensive eye exam during the first trimester and close follow-up with an eye doctor during their pregnancy. (This recommendation does not apply to women who develop gestational diabetes.)

Gastroparesis

Diabetes increases your risk of gastroparesis. With gastroparesis, the nerves to the stomach are damaged and stop working properly. This causes the stomach to take too long to empty its contents and makes it difficult to manage blood glucose levels. Sometimes changing your diet can help. There are some medications and treatments for gastroparesis.
Talk to your doctor about ways to prevent diabetes complications. Ask for information on early warning signs so you can seek treatment when it is most effective.

Erectile Dysfunction

Diabetes increases the chance of developing erectile dysfunction, or impotence. For some men, adopting a healthier lifestyle, such as quitting smoking, exercising regularly, and reducing stress, may be all that is needed to resolve erectile dysfunction. In this health topic, you'll also learn why it's important to talk to your health care provider about your erectile dysfunction as your doctor can recommend other remedies -- including medications, a vacuum constriction device (VCD), and other erectile dysfunction aids -- that can help.

Skin Problems

As many as a third of people with diabetes will have a skin condition related to their disease at some time in their lives. High levels of glucose in the blood provide an excellent breeding ground for bacteria and fungi and can reduce the body's ability to heal itself. Fortunately, most skin conditions can be prevented and successfully treated if caught early. If your skin is not cared for properly with type 2 diabetes, a minor skin condition can turn into a serious problem with potentially severe consequences.

Infection

Type 2 diabetes slows down your body's ability to fight infection. High blood glucose leads to high levels of sugar in your body's tissues. When this happens, bacteria grow and infections can develop more quickly. Common sites of infection are your bladder, kidneys, vagina, gums, feet, and skin. Early treatment of infections can prevent more serious complications.

Dental Problems in Diabetes

People with diabetes face a higher than normal risk of serious dental and oral health problems. The more uncontrolled the blood sugar, the more likely dental and oral health problems will arise. This is because uncontrolled diabetes impairs white blood cells, which are the body's main defense against infections that can occur in the mouth. Whether you have diabetes or not, be sure to see your dentist for regular cleanings and checkups to prevent serious dental problems.

Reviewed by Brunilda Nazario, MD on October 17, 2011

© 2011 WebMD, LLC. All rights reserved.

Taking Care of Your Diabetes Every Day; 4 everyday tips

The four things you have to do every day to lower high blood sugar are:

1. Eat healthy food

2. Get regular exercise

3. Take your diabetes medicine

4. Test your blood sugar.

Experts say most people with diabetes should try to keep their blood sugar level as close as possible to the level of someone who does not have diabetes. This may not be possible or right for everyone. Check with your doctor about the right range of blood sugar for you.

You will get plenty of help in learning how to do this from your health care providers. Your main health care providers are your doctor, nurse, and dietitian. (A dietitian is someone who is specially trained to help people plan their meals.)

Bring a family member or friend with you when you see your doctor. Ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.

Eat Healthy Food

People with diabetes do not need special foods. The foods on your diabetes eating plan are the same foods that are good for everyone in your family! Try to eat foods that are low in fat, salt, and sugar and high in fiber such as beans, fruits and vegetables, and grains. Eating right will help you:

1. Reach and stay at a weight that is good for your body.

2. Keep your blood sugar in a good range.

3. Prevent heart and blood vessel disease.

People with diabetes should have their own eating plan. Ask your doctor to give you the name of a dietitian who can work with you to develop an eating plan for you and your family. Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you.

Action Steps...

If You Use Insulin

• Give yourself an insulin shot before you eat.
• Eat at about the same time and the same amount of food every day.
• Don't skip meals, especially if you have already given yourself an insulin shot because your blood sugar may go too low. 

If You Don't Use Insulin

• Follow your meal plan.
• Don't skip meals, especially if you take diabetes pills because your blood sugar may go too low. Skipping a meal can make you eat too much at the next meal. It may be better to eat several small meals during the day instead of one or two big meals.

Get Regular Exercise

Exercise is good for those with diabetes. Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise. You can even get exercise when you clean house or work in your garden. Exercise is especially good for people with diabetes because:

1. Exercise helps keep weight down.

2. Exercise helps insulin work better to lower blood sugar.

3. Exercise is good for your heart and lungs.

4. Exercise gives you more energy.

Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weight-lifting may not be safe. Your doctor or nurse will help you find safe exercises.

Try to exercise regularly. Exercise at least three times a week for about 30 to 45 minutes each time. If you have not exercised in a while, begin slowly. Start with five to 10 minutes, and then work up to more time.

If you haven't eaten for over an hour or if your blood sugar is less than 100-120, eat or drink something like an apple or a glass of milk before you exercise.

When you exercise, carry a snack with you in case of low blood sugar. Wear or carry an identification tag or card saying that you have diabetes.

Regular exercise such as walking and bicycling can help keep your blood sugar in a good range.

Action Steps...

If You Use Insulin

• Exercise after eating, not before.
• Test your blood sugar before, during, and after exercising. Don't exercise when your blood sugar is over 240.
• Avoid exercise right before you go to sleep, because it could cause low blood sugar during the night.

If You Don't Use Insulin

• See your doctor before starting an exercise program.
• Test your blood sugar before and after exercising if you take diabetes pills.

Take Your Diabetes Medicine Every Day

Insulin and diabetes pills and injections (Byetta, Symlin, or Victoza) are the kinds of medicines used to lower blood sugar.

If You Use Insulin

You need insulin if your body has stopped making insulin or if it doesn't make enough insulin. Everyone with insulin-dependent diabetes (or type 1 diabetes) needs insulin, and many people with type 2 diabetes need insulin.

Insulin cannot be taken as a pill. You will have to give yourself shots every day. Some people give themselves one shot a day. Some people give themselves two or more shots a day. You need to take your insulin every day. Never skip a shot, even if you are sick.

Insulin is injected with a needle. Your doctor will tell you what kind of insulin to use, how much, and when to give yourself a shot. Talk to your doctor before changing the type or amount of insulin you use or when you give your shots. Your doctor or the diabetes educator will show you how to draw up insulin in the needle. They will also show you the best places on your body to give yourself a shot. Ask someone to help you with your shots if your hands are shaky or you can't see well.

Good places on your body to give shots are:

• The outside part of your upper arms.
• Around your waist and hips.
• The outside part of your upper legs.
• Avoid areas with scars and stretch marks.
• Ask your doctor or nurse to check your skin where you give your shots.

You may be a little afraid at first to give yourself a shot. But most people find that the shots hurt less than they expected. The needles are small and sharp and do not go deep into your skin. Always use your own needles and never share them with anyone else.

Your doctor or diabetes educator will tell you how to throw away used needles safely.

Keep extra insulin in your refrigerator in case you break the bottle you are using. Do not keep insulin in the freezer or in hot places like the glove compartment of your car. Also, keep it away from bright light. Too much heat, cold, and bright light can damage insulin.

If your body makes insulin, but the insulin doesn't lower your blood sugar, you may have to take diabetes pills. Diabetes pills only work in people who have some insulin of their own. Some pills are taken once a day, some are taken more often. Ask your doctor when you should take your pills.

Diabetes pills are safe and easy to take. Be sure to tell your doctor if your diabetes pills make you feel bad or if you have any other problems. Remember, diabetes pills do not lower blood sugar all by themselves. You will still have to follow an eating plan and exercise to help lower your blood sugar.

Sometimes, people who take diabetes pills may need insulin shots for a while. This may happen if you get very sick, need to go to a hospital, or become pregnant. You may need insulin shots if the diabetes pills no longer work to lower your blood sugar.

You may be able to stop taking diabetes pills if you lose weight. Losing even a little bit of weight can sometimes help to lower your blood sugar.

If You Don't Use Insulin or Take Diabetes Pills 

 

Many people with type 2 diabetes don't have to use insulin or take diabetes pills. However, everyone with diabetes needs to follow their doctors advice about eating and getting enough exercise.

Ask your doctor when you should take your pills or insulin. Tell your other doctors that you take insulin or diabetes pills.

Test Your Blood Sugar Every Day

You need to know how well you are taking care of your diabetes. You need to know if you are lowering your high blood sugar. The best way to find out is to test your blood to see how much sugar is in it. If your blood has too much or too little sugar in it, your doctor may need to change your eating, exercise, or medicine plan.

Some people test their blood once a day. Others test their blood three or four times a day. Your doctor may want you to test before eating, before bed, and sometimes in the middle of the night. Ask your doctor how often and when you should test your blood sugar. 

 

How to Test Your Blood Sugar

 

To test your blood, you need a small needle called a lancet. You also need special blood testing strips that come in a bottle. Your doctor or diabetes educator will show you how to test your blood. Here are the basic steps to follow:

1. Depending on your home glucose monitoring device, prick your finger or another area of your body with the lancet to get a drop of blood.

2. Place the blood on the end of the strip.

3. Put the strip into the meter. The meter will display a number for your blood sugar, like 128.

Pricking your finger with a lancet may hurt a little. It's like sticking your finger with a pin. Use the lancet only once and be careful when you throw away used lancets. Ask your doctor or nurse how to throw them away safely.

You can buy lancets, strips, and meters at a drug store. Some of these items are costly, especially the blood testing strips. Lancets do not cost very much, and meters are often on sale. There are many different kinds of meters available in drug stores. If you decide to buy one, ask your doctor or diabetes educator for advice on what kind to buy. Take your blood testing items with you when you see your doctor or nurse so that you can learn how to use them correctly.

Other Tests for Your Diabetes

Urine Tests

You may need to test your urine or blood for ketones when you are sick or if your blood sugar is over 240 before eating a meal. These test will tell you if you have "ketones" in your urine or blood. Your body makes ketones when there is not enough insulin in your blood. Ketones can make you very sick. Call your doctor right away if you find ketones when you test. You may have a sickness called "ketoacidosis." Ketoacidosis is serious. If not treated, it can cause death. Signs of ketoacidosis are vomiting, weakness, fast breathing, and a sweet smell on the breath. Ketoacidosis is more likely to develop in people with insulin-dependent diabetes.

You can buy strips for testing urine ketones at a drug store. Also, some blood glucose meters can detect ketones with specializes strips. Your doctor or diabetes educator will show you how to use testing monitors correctly.

The Hemoglobin A1c Test

 

Another test for blood sugar, the hemoglobin A1c test, shows what your average blood sugar was for the past 3 months. It shows how much sugar is sticking to your red blood cells. The doctor does this test to see what level your blood sugar is most of the time.

See your doctor for a hemoglobin A1c test every three months. To do the test, the doctor or nurse takes a sample of your blood. The blood is tested in a laboratory. The laboratory sends the results to your doctor.

If most of the blood sugar tests you do yourself show that your blood sugar is around 150, the hemoglobin A1c test should be almost near optimal levels. If most of your tests show high levels of blood sugar, then the hemoglobin Alc test is usually high. Ask your doctor what your hemoglobin A1c test showed.

 
Keep Daily Records
 

Write down the results of your blood tests every day in a record book. You can use a small notebook or ask your doctor for a blood testing record book. You may also want to write down what you eat, how you feel, and how much you have exercised.

By keeping daily records of your blood and urine tests, you can tell how well you are taking care of your diabetes. Show your book to your doctor. The doctor can use your records to see if you need to make changes in your insulin shots or diabetes pills, or in your eating plan. Ask your doctor or nurse if you don't know what your test results mean.

Things to write down every day in your notebook are:

• if you had very low blood sugar
• if you ate more or less food than you usually do
• if you felt sick or very tired
• what kind of exercise you did and for how long

Reviewed by Brunilda Nazario, MD on October 28, 2011

© 2010-2011 WebMD, LLC. All rights reserved.

12 Possible Heart Symptoms Never to Ignore

Don't miss these 12 possible warning signs that something is amiss with your heart.

Heart disease is the No. 1 killer of U.S. men and women, accounting for 40% of all U.S. deaths. That's more than all forms of cancer combined.

Why is heart disease so deadly? One reason is that many people are slow to seek help when symptoms arise. Yes, someone gripped by sudden chest pain probably knows to call 911. But heart symptoms aren't always intense or obvious, and they vary from person to person and according to gender.

Because it can be hard to make sense of heart symptoms, doctors warn against ignoring possible warning signs, toughing them out, waiting to see if they go away, or being quick to blame them on heartburn, muscle soreness, or other less serious, noncardiac causes. That's especially true for men and people over 65, as well as for people with other cardiac risk factors, such as high cholesterol or blood pressure, obesity, smoking, diabetes, or a family history of heart disease.

"The more risk factors you have, the higher the likelihood that a symptom means something is going on with your heart," says David Frid, MD, a cardiologist at the Cleveland Clinic. "People often don't want to admit that they're old enough or sick enough to have heart trouble. Putting off treatment for other medical problems might not be so bad, but a serious heart problem can mean sudden death. It's better to go in and get it evaluated than to be dead."

12 Possible Heart Symptoms Never to Ignore

Here are a dozen symptoms that may signal heart trouble.
1. Anxiety. Heart attack can cause intense anxiety or a fear of death. Heart attack survivors often talk about having experienced a sense of "impending doom."
 
2. Chest discomfort. Pain in the chest is the classic symptom of heart attack, and "the No. 1 symptom that we typically look for," says Jean C. McSweeney, PhD, RN, associate dean for research at the University of Arkansas for Medical Sciences College of Nursing in Little Rock and a pioneer in research on heart symptoms in women. But not all heart attacks cause chest pain, and chest pain can stem from ailments that have nothing to do with the heart.

Heart-related chest pain is often centered under the breastbone, perhaps a little to the left of center. The pain has been likened to "an elephant sitting on the chest," but it can also be an uncomfortable sensation of pressure, squeezing, or fullness. "It's not unusual for women to describe the pain as a minor ache," McSweeney says. "Some women say the pain wasn't bad enough even to take a Tylenol."

Women, more so than men, can also experience a burning sensation in their chest, rather than a pressure or pain.  "Sometimes people make the mistake that the pain comes from a stomach problem," says Nieca Goldberg, MD, clinical associate professor of medicine at the NYU Langone Medical Center in New York City and another expert on women's heart symptoms.

3. Cough. Persistent coughing or wheezing can be a symptom of heart failure -- a result of fluid accumulation in the lungs. In some cases, people with heart failure cough up bloody phlegm.
 
4. Dizziness. Heart attacks can cause lightheadedness and loss of consciousness.  So can potentially dangerous heart rhythm abnormalities known as arrhythmias.
 
5. Fatigue. Especially among women, unusual fatigue can occur during a heart attack as well as in the days and weeks leading up to one. And feeling tired all the time may be a symptom of heart failure.

Of course, you can also feel tired or fatigued for other reasons. How can you tell heart-related fatigue from other types of fatigue?

"If you don't feel well and all the wind is knocked out of your sails, don't try to figure it out on the Internet or from a book," says Goldberg.  "Wasting time is dangerous."
 
6. Nausea or lack of appetite. It's not uncommon for people to feel sick to their stomach or throw up during a heart attack. And abdominal swelling associated with heart failure can interfere with appetite.
 
7. Pain in other parts of the body. In many heart attacks, pain begins in the chest and spreads to the shoulders, arms, elbows, back, neck, jaw, or abdomen. But sometimes there is no chest pain -- just pain in these other body areas.  The pain might come and go.

Men having a heart attack often feel pain in the left arm. In women, the pain is more likely to be felt in both arms, or between the shoulder blades.
 
8. Rapid or irregular pulse. Doctors say that there's nothing worrisome about an occasional skipped heartbeat. But a rapid or irregular pulse -- especially when accompanied by weakness, dizziness, or shortness of breath -- can be evidence of a heart attack, heart failure, or an arrhythmia. Left untreated, some arrhythmias can lead to stroke, heart failure, or sudden death.
 
9. Shortness of breath. People who feel winded at rest or with minimal exertion might have a pulmonary condition like asthma or chronic obstructive pulmonary disease (COPD). But breathlessness could also indicate a heart attack or heart failure.

"Sometimes people having a heart attack don't have chest pressure or pain but feel extremely short of breath," Goldberg says. "It's like they've just run a marathon when they haven't even moved." During a heart attack, shortness of breath often accompanies chest discomfort, but it can also occur before or without chest discomfort.
 
10. Sweating. Breaking out in a cold sweat is a common symptom of heart attack. "You might just be sitting in a chair when all of a sudden you are really sweating like you had just worked out," Frid says.
 
11. Swelling. Heart failure can cause fluid to accumulate in the body. This can cause swelling (often in the feet, ankles, legs, or abdomen) as well as sudden weight gain and sometimes a loss of appetite.
 
12. Weakness. In the days leading up to a heart attack, as well as during one, some people experience severe, unexplained weakness. "One woman told me it felt like she couldn't hold a piece of paper between her fingers," McSweeney says.

By David Freeman
WebMD Feature
©2005-2011 WebMD, LLC. All rights reserved.

A Guide to High Blood Pressure

What Is Hypertension?

Hypertension, or high blood pressure, is a common condition that will catch up with most people who live into older age. Blood pressure is the force of blood pressing against the walls of your arteries. When it's too high, it raises the heart's workload and can cause serious damage to the arteries. Over time, uncontrolled high blood pressure increases the risk of heart disease, stroke, and kidney disease.

Hypertension Symptoms

High blood pressure is sometimes called a silent killer because it may have no outward symptoms for years. In fact, one in five people with the condition don't know they have it. Internally, it can quietly damage the heart, lungs, blood vessels, brain, and kidneys if left untreated. It's a major risk factor for strokes and heart attacks in the U.S.

What Causes Hypertension?

Normal blood pressure readings will fall below 120/80, while higher results over time can indicate hypertension. In most cases, the underlying cause of hypertension is unknown. The top number (systolic) shows the pressure when your heart beats. The lower number (diastolic) measures pressure at rest between heartbeats, when the heart refills with blood. Occasionally, kidney or adrenal gland disease can lead to hypertension.

Prehypertension: A Warning Sign

Almost one-quarter of Americans have prehypertension. Their blood pressure is consistently just above the normal level -- falling anywhere between 120 and 139 for systolic pressure or 80 to 89 for the diastolic pressure. People in this range have twice the risk of developing heart disease than those with a lower reading. Your doctor may recommend lifestyle changes to help lower your blood pressure.

The Hypertension Danger Zone

You have high blood pressure if readings average140/90 or higher -- for either number -- though you may still have no symptoms. At 180/110 and higher, you may be having a hypertensive crisis. Rest for a few minutes and take your blood pressure again. If it is still very high, call 911. A hypertensive crisis can lead to a stroke, heart attack, kidney damage, or loss of consciousness. Symptoms of a hypertensive crisis can include a severe headache, anxiety, nosebleeds, and feeling short of breath.

Who Gets High Blood Pressure?

Up to the age of 45, more men have high blood pressure than women. It becomes more common for both men and women as they age, and more women have hypertension by the time they reach 65. You have a greater risk if a close family member has high blood pressure or if you are diabetic. About 60% of people with diabetes have high blood pressure.

Hypertension and Race

African-Americans are more likely to develop hypertension -- and to develop it at a younger age. Genetic research suggests that African-Americans seem to be more sensitive to salt. In people who have a gene that makes them salt-sensitive, just a half-teaspoon of salt can raise blood pressure by 5 mm Hg. Diet and excessive weight can play a role, as well.

Hypertension and Sodium

Sodium, a major component of salt, can raise blood pressure by causing the body to retain fluid, which leads to a greater burden on the heart. The American Heart Association recommends eating less than 1,500 milligrams of sodium per day. You'll need to check food labels and menus carefully.  Processed foods contribute up to 75% of our sodium intake. Canned soups and lunch meats are prime suspects.

Hypertension and Stress

Stress can make your blood pressure spike, but there's no evidence that it causes high blood pressure as an ongoing condition. However, stress may affect risk factors for heart disease, so it may have an indirect connection to hypertension. Stress may lead to other unhealthy habits, such as a poor diet, alcohol use, or smoking, which can contribute to high blood pressure and heart disease.

Hypertension and Weight

Being overweight places a strain on your heart and increases your risk of high blood pressure. That is why diets to lower blood pressure are often also designed to control calories. They typically call for cutting fatty foods and added sugars, while increasing fruits, vegetables, lean protein, and fiber.  Even losing 10 pounds can make a difference.

Hypertension and Alcohol

Drinking too much alcohol can increase your blood pressure. Guidelines from the American Heart Association state that if you drink alcohol, you should limit the amount to no more than two drinks a day for men, or one a day for women. They define a drink as one 12-ounce beer, four ounces of wine, 1.5 ounces of 80-proof spirits, or one ounce of 100-proof spirits.

Hypertension and Caffeine

If caffeine can make you jittery, can it also raise your blood pressure? It might have a temporary effect, but studies haven't shown any link between caffeine and the development of hypertension. You can safely drink one or two cups a day, according to the American Heart Association.

Hypertension and Pregnancy

Gestational hypertension is a kind of high blood pressure that occurs in the second half of pregnancy. Without treatment, it may lead to a serious condition called preeclampsia that endangers both the mother and baby. The condition can limit blood and oxygen flow to the baby and can affect  the mother's kidneys and brain. After the baby is born, the mother’s blood pressure usually returns to its normal level.

Hypertension and Medicine

Cold and flu medicines that contain decongestants are one of several classes of medicine that can cause your blood pressure to rise. Others include NSAID pain relievers, steroids, diet pills, birth control pills, and some antidepressants. If you have high blood pressure, talk to you doctor about what medicines and supplements you are taking that may affect blood pressure.

'White Coat' Hypertension

Some people only have a high reading in the doctor's office, perhaps because they're nervous. Some will only have blood pressure readings sporadically. Those people may have a higher chance of developing high blood pressure, a recent study shows. To get a more accurate reading, take your blood pressure at home, chart your readings, and share them with your doctor. It is also a good idea to bring in your home monitor in for a check of the device and your technique.

Hypertension and Children

While hypertension is more often a problem for older people, even children can have high blood pressure. "Normal" blood pressure varies based on a child’s age, height, and sex, so your doctor will need to tell you if there is a concern. Children are at greater risk if they are overweight, have a family history of the illness and if they're African-American.

Treatment: The DASH Diet

You may be able to lower your blood pressure by switching to a better diet. The DASH Diet -- Dietary Approaches to Stop Hypertension -- involves eating more fruits, vegetables, whole-grain foods, low-fat dairy, fish, poultry, and nuts. You should eat less red meat, saturated fats, and sweets. Reducing sodium in your diet can also have a significant effect.

Treatment: Exercise

Regular exercise helps lower your blood pressure. Adults should get about 150 minutes of moderate-intensity exercise every week. That could include gardening, walking briskly, bicycling, or other aerobic exercise. Muscle-strengthening activities are recommended at least two days a week and should work all major muscle groups.

Treatment: Diuretics

Diuretics are often the first choice if diet and exercise changes aren't enough. Also called "water pills," they help the body shed excess sodium and water to lower blood pressure. That means you'll urinate more often. Some diuretics may deplete your body's potassium, causing muscle weakness, leg cramps, and fatigue. Some can increase blood sugar levels in diabetics. Erectile dysfunction is a less common side effect.

Treatment: Beta-blockers

Beta-blockers work by slowing the heart rate, which means that the heart doesn't have to work as hard. They are also used to treat other heart conditions, such as an abnormal heart rate called arrhythmia. They may be prescribed along with other medications. Side effects can include insomnia, dizziness, fatigue, cold hands and feet, and erectile dysfunction.

Treatment: ACE Inhibitors

ACE inhibitors reduce your body's supply of angiotensin II -- a substance that makes blood vessels contract and narrow. The result is more relaxed, open (dilated) arteries, as well as lower blood pressure and less effort for your heart. Side effects can include a dry cough, skin rash, or dizziness, and high levels of potassium. Women should not become pregnant while taking an ACE inhibitor.

Treatment: ARBs

Instead of reducing your body's supply of angiotensin II, these drugs block receptors for angiotensin -- as if placing a shield over a lock. This blockade prevents the chemical's artery-tightening effects, and lowers your blood pressure. ARBs can take several weeks to become fully effective. Possible side effects include dizziness, muscle cramps, insomnia, and high levels of potassium. Women should not become pregnant while taking this medication.

Treatment: Calcium Channel Blockers

Calcium channel blockers slow the movement of calcium into the cells of the heart and blood vessels. Since calcium causes stronger heart contractions, these medications ease the heart's contraction and relax the blood vessels. They can cause dizziness, heart palpitations, swelling of the ankles, and constipation. Take them with food or milk and avoid grapefruit juice and alcohol because of possible interactions.

Treatment: Other Medications

Other medications that relax the blood vessels include vasodilators, alpha blockers, and central agonists. Side effects can include dizziness, a fast heart beat or heart palpitations, headaches, or diarrhea. Your doctor may suggest them if other blood pressure medications are not working well enough or if you have another condition.

Treatment: Complementary Therapies

Meditation can put your body into a state of deep rest, which can lower your blood pressure. Yoga, tai chi, and deep breathing also help. These relaxation techniques should be combined with other lifestyle changes, such as diet and exercise. Be aware that herbal therapies may conflict with other medications you take, and some herbs actually raise blood pressure. Tell your doctor if you take herbal or other dietary supplements.

Living With High Blood Pressure

Hypertension is often a life-long condition. It's important to take your medications and continue to monitor your blood pressure. If you keep it under control, you can reduce your risk of stroke, heart disease, and kidney failure.

Accompanying Slideshow at: http://www.webmd.com/hypertension-high-blood-pressure/ss/slideshow-hypertension-overview?ecd=wnl_hyp_110311

Reviewed by Louise Chang, MD on February 15, 2011
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