In general, the difference in blood pressure of the upper limbs on both sides is more than 20 mmHg, and it is necessary to be vigilant about whether the blood vessels are diseased.
Look at a case.
A 59-year-old man with a long history of hypertension has recently been 180-190/100 mmHg and has been treated with sacubabic valsartan due to decreased cardiac function. Recently, however, it has been found that the blood pressure in the left arm has decreased significantly.
There is a previous history of "COPD", and whether there is a history of asthma is unclear. Drink 3 to 4 drinks a day, smoke for more than 40 years, more than 20 sticks.
Blood pressure measurement: left upper extremity 134/88mmHg, right upper extremity 182/96mmHg, heart rate 96 beats/min, left subclavian can be heard vascular murmur, both carotid arteries have murmurs, the left side is obvious.
Hypertensive patients, long-term smoking, drinking history, one arm blood pressure significantly reduced, systolic blood pressure difference of nearly 50mmHg, check that there are multiple parts of the blood vessel noise, to consider whether the blood vessels in these parts are narrow. Therefore, an ultrasound of the blood vessels is done first.
Ultrasound really found a problem. Both carotid arteries have hardening and atherosclerotic plaques, the right internal carotid artery has a 50 to 69% stenosis at the beginning, the left subclavian artery is not clear, and the left vertebral artery has reverse blood flow. Therefore, ultrasound is considered to have "subclavian artery theft syndrome".
Let's talk about this "subclavian artery theft syndrome".
Simply put, the blood flow that should have flowed from the subclavian artery to the vertebral artery to the brain, reverses back to the subclavian artery, and flows to the upper limbs. Blood from the vertebral arteries was "stolen" by the subclavian arteries. At this time, in addition to finding narrowing and occlusion of the subclavian artery, ultrasonography can also find that the blood flow of the vertebral artery is reversed.
Why does the subclavian artery "steal blood"?
Because the subclavian artery begins, or the previous nameless artery is narrowed or blocked.
After the blood vessels are narrowed or blocked, blood flow is reduced, and the blood flow that the subclavian arteries should supply the vertebral arteries and upper extremities is reduced. Because the vertebral arteries can get blood on the opposite side and blood supply, the upper limbs are not working, and the pressure in the blood vessels is lower. In this way, a kind of "siphoning" effect is created, sucking the blood that should have flowed into the vertebral artery to supply the brain and flowing to the upper limbs. And the more the upper limbs move, the more pronounced it becomes.
What are the manifestations of subclavian artery hemophilia syndrome?
It is mainly a manifestation of insufficient cerebral blood supply and upper limb ischemia, and mild ones can also have no symptoms.
Insufficient blood supply to the brain. The vertebral arteries mainly supply blood to the cerebellum, brainstem and part of the brain, and the corresponding dysfunction will occur if the blood supply is insufficient, such as dizziness, unclear seeing, ghosting, uncoordinated movements, unclear pronunciation, difficulty swallowing, etc. Because upper limb activity can exacerbate ischemia, some patients develop symptoms while upper extremity is moving.
Upper extremity ischemia manifestations. Blood theft originally occurred because of ischemia in the upper limbs. The ischemic arm can be weak, painful, the skin can be pale and cold, and the examination will find that the pulse beat is weakened, the blood pressure is significantly lower than the contralateral side, mainly the systolic blood pressure is significantly reduced, just like this patient.
Cause of stenosis of the subclavian arteries
Peripheral atherosclerotic disease is an independent risk factor, along with aortic dissection, congenital development or anatomical abnormalities.
In the past, it was said that aorticitis was high in young people, and now the elderly should also be vigilant. Not long ago, we had an 80-year-old man diagnosed with multiple aorticitis because of this condition.
Inferior clavicle artery stenosis and hematosis syndrome, previously thought to be rare or even rare diseases, are now detected with the advancement of examination technology, especially the development of ultrasound technology, and many asymptomatic patients have been detected. However, further examination requires angiography of blood vessels, including magnetic resonance imaging, CT, and catheter contrast. Treatment has vascular intervention, just like coronary heart disease stents, balloon dilation, stents to open blood vessels, but also to do surgical vascular bypass surgery.
In this patient, he was advised to first have an MRI angiogram of the carotid artery and further find the cause if necessary.
This patient is a patient with many cardiovascular risk factors. Alcohol dependence, heavy smoking, high blood pressure for many years without a good blood pressure, heart function began to be bad.
The following treatment was done:
Lifestyle improvement, limit smoking and drinking to gradually quit smoking and alcohol.
Intensive antihypertensive therapy, because the previous use of sakubatri valsartan, so the addition of calcium antagonists such as levlodipine; the patient's heart rate is fast, but there is COPD, asthma history can not be excluded, temporarily no lore β blockers are given.
Pitvastatin is given lipid-lowering therapy.
Homocysteine is elevated, and a small dose of folic acid is added.
Magnetic resonance angiography.
About blood tests.
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