The Man Whose Arm Has No Blood Pressure Reading

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The medical profession can be funny at times. With years of practice, a clinician may encounter a "new" problem whose management he or she has not observed anywhere. Such cases often send the medical practitioner back to read his books.

Mr A was referred to me many years ago. After the routine history taking, it was time to examine him.

I picked his arm closer to me to wrap the cuff of the Blood Pressure machine around it.

"Doctor, don't use this one," he suggested.

"Why?" I asked.

"You will not get my blood pressure," he replied as he pulled up the sleeve around the other arm for me to check the pressure.

I was curious. I wanted to confirm what he meant, so I requested to first check the blood pressure on the arm he advised me not to use.

An error reading flashed on the digital BP machine. He chuckled, "I told you."

Error readings on BP machines could be "E1, E2 ... E5 and Er" if the BP is too high or too low to be measured by the machine, the machine is faulty, the cuff is not wrapped properly around the arm, amongst other technical problems with measurement.

I rechecked the BP on same arm, more careful this time. An error reading flashed again. 

I checked his other arm; a normal blood pressure below 120/80mmHg showed on the machine.

Still curious about the weird observation, I returned to the "non-functional" arm to check again; no blood pressure could be recorded.

The patient cooperated as I used him for my brief experiment.

"Ahn Ahn!" I quietly exclaimed at the strange observation. I had never seen a patient whose arm had no blood pressure reading despite being well.

I asked him how long he had known such discordant blood pressure measurements in his arms.

"Since I started checking my blood pressure," he responded.

"Didn't the doctors advise you to investigate the probable causes of absent blood pressure on your arm?"

He gave an evasive answer.

He was counseled that many things could be wrong in his body even though he seemed well all the while. He was referred to see a Vascular Surgeon for comprehensive evaluation.


.........................................................................


When an individual becomes an adult (18 years old and above), he or she is required to check the blood pressure during every hospital visit for any medical complaint. Hypertension being a silent killer needs to be detected early, hence, blood pressure is checked irrespective of the person's illness.

In most clinical settings, the blood pressure on one arm only is checked. This habit may be due to the heavy patient load in the health facilities. Ideally, both arms should be checked because of uncommon cases found in Mr A who may have significantly dissimilar readings on both arms.

In most persons, the difference between the systolic blood pressures (numerators) of the right arm and left arm is small. This difference is called Inter-Arm Difference (IAD). 



IAD less than 5mmHg is regarded as normal. When IAD is more than 10mmHg, it may be a normal finding (no problem in the body) or evidence that there is a disease in the affected arm or body responsible for the large difference. 

Ideally, IAD > 10mmHg (as in the case of Mr A) should be investigated in the affected individual.

Some problematic reasons why IAD may be more than 10mmHg include


- A muscle pressing on the artery in one of the arms.

- Abnormal narrowing in the space within the artery of one of the arms.

- Abnormal narrowing of the aorta (the big artery connected to the heart) from birth.

- Inflammation of the artery (Vasculitis) in one of the arms.

If IAD > 10mmHg, the arm with the higher systolic blood pressure should be used for blood pressure check subsequently. It may be the right arm in one person; the left arm in another. 

If IAD is =< 10mmHg, any arm can be used to check the BP subsequently since the values are close.

Ademola Orolu


About the Author

Ademola is a Consultant Family Physician and writer. He founded the online health magazine, The Family Doctors, and was its Editor-in-Chief from 2017 to 2020. He is the medical director of Nathaniel Health Consulting, a family hospital in Matogbun, Ogun State. 

He is an author of many books including storybooks. He regularly writes on health-promoting topics and encourages positive behavioural change in his articles.


Comments

  1. AnonymousOctober 3, 2023 at 10:21 PM

    If the blood vessel is compromised so much, then there should be a difference in the size of the arm, don't you think 🤔. It'll be good to know the cause though. A great part 2 case if you wan find trouble

    ReplyDelete
    Replies
    1. Ademola OroluOctober 4, 2023 at 3:29 AM

      Interestingly, his arms are symmetrical. If they aren't, perhaps he would have sought care earlier. He was lost to follow up. Yes, it's a good part 2 case (inclusive of the trouble).😆😆

      Delete

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