Steals My Pressure

Author: Diana George / Editor: Nick Tilbury / Codes: / Published: 10/12/2021

A 74-year- old man presents to the Emergency Department (ED) complaining of intermittent dizziness for the last week. He tells you it is more marked when he uses his left upper limb. He also tells you he had an episode of syncope the previous day and was unconscious for a few minutes. He denies any chest pain, speech or visual disturbances, limb weakness, or anything else out of the ordinary.

His past medical history includes hypertension, coronary artery disease, ischemic cardiomyopathy, asthma, and chronic kidney disease. He has also undergone left cataract surgery two weeks before.

His initial observations are:

  • Heart rate – 80 beats per minute
  • Blood pressure – 170/100mmHg (right arm) 140/100mmHg (left arm)
  • Respiratory rate – 16 per minute
  • SpO2 – 98% on air
  • Temperature – 37 C

Cardiovascular examination reveals a radio-radial delay and an audible bruit in the left supraclavicular fossa. Clinical examination is otherwise unremarkable.

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