Understanding your blood pressure after spinal cord injury

Understanding your blood pressure after spinal cord injury

Posted by AskNurseLinda on May 7, 2018 10:09 am

6c87f13ebc5fbf5b742a090e95b82550-huge-blBlood pressure is a measurement of the pressure of your blood circulating in your body. It is the force of blood against your blood vessels. Your heart is a pump which pushes blood through your circulation. The blood pressure measurement is the amount of force of that pumping in your arteries. Sometimes the heart has to pump more forcefully and other times not so hard.  

Blood pressure is reported in mm Hg which stand for millimeters of mercury. Hg is the anatomical symbol for mercury. If you think of those really old blood pressure measurement devices, mercury would be pushed up a tube as blood pressure was assessed. The mercury would ‘bounce’ with the heartrate. Those devices are now out of use because of the toxic effects of mercury should they break.

Blood pressure measurement depends on two things. One is what you are doing. If you are exercising your blood pressure will elevate as your heart beats faster to accommodate the needed circulation. The other element of blood pressure is the blood vessels which can lose elasticity over time making them more ridged which makes the heart beat faster or harder to pump your blood throughout your body.

After spinal cord injury, the nerves to your heart can be affected leading to a slowdown in pumping to accommodate circulation as the message to pump faster or harder is not received. Most often people with spinal cord injury or disease will notice this when changing position, like from lying to sitting. Because the heart does not get the message to automatically adjust and the blood vessels might not receive the message to react by constricting in the legs to force more blood to the brain, dizziness or even passing out can occur.

Most individuals have experienced this faint feeling, called hypotension, early in their injury or in disease it might be experienced later as more effects are realized. However, this problem with adapting to changing positions can reappear later as well as your body ages. You might also have this feeling should you become dehydrated so the volume of blood to pump around your body is less. Some medications have the effect of hypotension so check your instructions to see if hypotension is a problem so you can be ready to address it.

Orthostatic Hypotension (OH) can be a huge disappointment when it reappears later in life. People feel they have left this issue behind in their recovery. The same treatments can be used to combat dizziness when elevating the head such as drinking fluids, use of compression stockings, ace wraps on the legs and abdominal binders. If you use this equipment from previous episodes, check to make sure the elastic is still functioning before using it again. The elastic can become fragile and snap, losing its ability to stretch. If you have some old compression stockings, make sure they are an appropriate size for your body now.

At the other end of blood pressure assessment is too much pressure in the vessels which leads to hypertension or high blood pressure. This can happen to anyone with or without a spinal cord injury. It is a result of too little exercise, poor diet, obesity, atherosclerosis or hardening of the arteries or even just your genetic makeup. Some people will become hypertensive just because they inherited the tendency.

With spinal cord injury, there are two events that particularly affect blood pressure. One is Autonomic Dysreflexia (AD) where the blood pressure suddenly raises. The first signs of AD might be a pounding headache, flushing face and changes in pulse that can be either fast or slow.  Blood pressure elevates by 20-40mm Hg over your normal average. Other symptoms include changes in vision, apprehension, nasal congestion, flushed skin, sweating, goosebumps, and/or tingling sensations.

Typically, AD is seen in individuals with spinal cord injury or disease above T6 however a few reports of AD have been reported with injury as low as T10. Some people have massive symptoms but others might have very faint issues. Some will have all of the symptoms but others might just have a few. There are even reports of individuals who have silent AD with no symptoms at all, not even realizing the change in their blood pressure. It is important to recognize AD as the effects of the wildly changing blood pressure can lead to cardiovascular and neurological events.

The first treatment for AD is to take advantage of the other issue in blood pressure regulation which is Orthostatic Hypotension (OH). Because blood vessels do not always adjust quickly when changing positions after spinal cord injury, the first treatment for AD is to raise the head quickly. This leads to OH, a sudden drop in blood pressure which allows minimal time to check for the cause of AD.  Causes of AD are most often a kinked or clogged catheter, bowel impaction, tight clothing, wrinkled clothing or sheets, pressure injury or other noxious stimuli that is misinterpreted by the brain.

Other, long term treatments for AD should be identified but in the emergent situation of AD, sitting up is the first treatment followed by other blood pressure lowering methods if not resolved.

Blood pressure is most often measured in the arm. The pressure is measured just above the pulse in the inner elbow. If you place your index and middle finger on the inner crease of the elbow, toward the inside of the body, you will find a pulse. The blood pressure cuff is placed around the upper arm. The bladder of the blood pressure cuff and the tubing from it should be just above the pulse point at the inner elbow. This will provide an accurate reading. A stethoscope is placed on the pulse point.

The blood pressure cuff is inflated until the bump/quiet of the pulse is no longer heard and then just a bit more. The cuff is slowly deflated. The top number of the blood pressure or systolic is when the bump/quiet is first heard through the stethoscope. The bottom number or diastolic is detected when the bump/quiet is no longer heard. That is your blood pressure.

The systolic number represents the force of blood through your arteries or when the heart is pushing blood through your circulation. The diastolic number is when your heart rests before squeezing again. So your blood pressure top number is the squeezing and the bottom number is the resting pressure.

Blood pressure can also be measured by automatic devices. You might have your blood pressure assessed in the hospital or healthcare provider’s office with a machine that has a cuff but no one listens with a stethoscope. The machine will note the systolic and diastolic numbers.

At home, you can assess your own blood pressure with a wrist device. You must read the instructions for use of your wrist device. Some will require the measurement box to be on top of the wrist and some placed on the inside of the wrist. All will tell you to place the device on your wrist and then position your wrist over or as high as your heart. The instructions typically indicate that you should not talk while assessing your blood pressure. Following the directions will provide an accurate blood pressure.

Take your blood pressure several times, on different days, at different times and with different activities or changes in position. Keeping a blood pressure journal with time, position, activity and emotions will help detect blood pressure issues.

You will see fluctuations in your blood pressure. It will be different each time you assess it. Find the average and that is your blood pressure. When you know your typical blood pressure, you will be able to report it should there be a dramatic change.  If the systolic and diastolic numbers are more than 40mm Hg, a wide pulse pressure might be diagnosed which can indicate atherosclerosis or other cardiac complication or even nothing at all.

Much like your pulse discussed last week, your normal blood pressure will most likely be lower than average. Therefore, if your blood pressure spikes, it might still be in the range of normal blood pressures for individuals without spinal cord injury. Therefore, a hypertensive crisis might not be noted. Be sure to tell any healthcare provider your average blood pressure to avoid complications of an undetected hypertension or hypotension.

Knowing your average blood pressure can help you detect issues in your cardiac health. You may find having your blood pressure assessed by your healthcare provider is all you need to do. For other individuals, especially for those with spinal cord injury effects assessing your blood pressure during different activities will help you detect changes.

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Re: Understanding your blood pressure after spinal cord injury

Posted by panistefanin on Jun 14, 2018 5:25 am

Thanks for the useful information! You helped me with advice!

Re: Understanding your blood pressure after spinal cord injury

Posted by KMGross on Sep 10, 2018 4:44 pm

Balancing my hypotension and AD has been difficult. Medication to increase my blood pressure worked for a little while but it compounded the effects of AD when it occurred so I had to stop. I am fortunate in that I just feel sluggish with my hypotension and do not pass out when healthy.

Also, severe UTI's/sepsis can cause both hypotension and hypertension. I have experienced both... Once at the same time, when I sat up it would drop really low (48/40) and when I lied down it would sky rocket (168/120). Once they got the infection under control it normalized, for me that is typically 70's/50's.

Re: Understanding your blood pressure after spinal cord injury

Posted by AskNurseLinda on Sep 10, 2018 5:15 pm

You might want to ask about thigh high elastic stockings and/or an abdominal binder. This will help with blood flow return and perhaps assist with evening out your blood pressure.  I hate for you to feel unwell when transitioning positions. Since these options are not internal, they should not affect your AD if you have the proper size binder and stockings. If you have these from your hospitalization, be sure the elastic is still functional. Elastic loses its compression ability as it ages and is washed.

Keep on top of the UTIs.  Prompt treatment is the key.

I want you to feel great! Nurse Linda

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