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Low Blood Pressure

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Low Blood Pressure

Blood pressure cuff

Image by frolicsomepl/Pixabay

Low Blood Pressure

Fainting - Is there any treatment?

Image by Painting by Pietro Longhi : The Yorck Project: 10.000 Meisterwerke der Malerei

Low Blood Pressure

You've probably heard that high blood pressure is a problem. Sometimes blood pressure that is too low can also cause problems.

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure. Your blood pressure reading uses these two numbers. Usually they're written one above or before the other, such as 120/80. If your blood pressure reading is 90/60 or lower, you have low blood pressure.

Some people have low blood pressure all the time. They have no symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of a medical condition or certain medicines. Some people may have symptoms of low blood pressure when standing up too quickly. Low blood pressure is a problem only if it causes dizziness, fainting or in extreme cases, shock.

Source: NIH: National Heart, Lung, and Blood Institute

Additional Materials (12)

5:08

Neurogenic Orthostatic Hypotension - Medical Animation

TreatNeurogenicOHNow/YouTube

4:22

Multiple System Atrophy and Neurogenic Orthostatic Hypotension

TreatNeurogenicOHNow/YouTube

1:59

How can you increase blood pressure if you have hypotension?

Top Doctors UK/YouTube

5:29

How to Perform Orthostatic Hypotension Testing

Med School Made Easy/YouTube

3:49

Types of Hypotension or Low Blood Pressure, Their Symptoms. And How to Manage?

MMAS Health/YouTube

42:02

Cardiovascular | Blood Pressure Regulation | Hypotension

Ninja Nerd/YouTube

7:17

Pulse Dosing For Hypotension

Larry Mellick/YouTube

12:20

Orthostatic Hypotension (Described Concisely)

PhysioPathoPharmaco/YouTube

1:35

Why Do I Get Dizzy When I Stand Up? Understanding Orthostatic Hypotension (OH) | TIME

TIME/YouTube

2:02

Shock Explained in 120 Seconds | Treatment, Symptoms, Causes | Video

Lifestyle by IK/YouTube

7:15

What is shock? | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

7:40

Shock - hemodynamics | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

What Is

Depiction of a hypotension patient getting her blood pressure checked

Image by https://www.myupchar.com

What Is Hypotension?

Low blood pressure is when blood flows through your blood vessels at lower than normal pressures.

Overview

Blood pressure is the force of blood pushing against the walls of your arteries as the heart pumps blood. It is usually described as two numbers: systolic and diastolic. The numbers record blood pressure in millimeters of mercury (mm Hg), with systolic listed above diastolic. For most adults, a healthy blood pressure is usually less than 120/80 mm Hg. Low blood pressure is blood pressure that is lower than 90/60 mm Hg.

Some people have low blood pressure all the time, and it is normal for them. Other people experience a sudden drop in blood pressure or have low blood pressure that may be linked to a health problem. Many systems of the body, including organs, hormones, and nerves, regulate blood pressure. For example, the autonomic nervous system sends the “fight-or-flight” signal that, depending on the situation, tells the heart and other systems in the body to increase or decrease blood pressure. Problems with the autonomic nervous system, such as in Parkinson’s disease, can cause low blood pressure.

Other causes of low blood pressure include medicines, bleeding, aging, and conditions such as dehydration, pregnancy, diabetes, and heart problems. Older adults have a higher risk for symptoms of low blood pressure, such as falling, fainting, or dizziness upon standing up or after a meal. Older adults are also more likely to develop low blood pressure as a side effect of medicines taken to control high blood pressure.

For many people, low blood pressure goes unnoticed. Others feel light-headed, confused, tired, or weak. You may have blurry vision, a headache, neck or back pain, nausea, or heart palpitations. Sitting down may relieve these symptoms. If blood pressure drops too low, the body’s vital organs do not get enough oxygen and nutrients. When this happens, low blood pressure can lead to shock, which requires immediate medical attention. Signs of shock include cold and sweaty skin, rapid breathing, a blue skin tone, or a weak and rapid pulse. If you notice signs of shock in yourself or someone else, call 9-1-1.

Your doctor will use a blood pressure test to diagnose low blood pressure. Other tests may include blood, urine, or imaging tests and a tilt table test if you faint often. You may not need treatment for low blood pressure. Depending on your signs and symptoms, treatment may include drinking more fluids, taking medicines to raise your blood pressure, or adjusting medicines that cause low blood pressure. Recommended lifestyle changes include changing what and how you eat and how you sit and stand up. Your doctor may also recommend compression stockings if you have to stand for long periods.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (1)

9:28

Low Blood Pressure Hypotension-Home Health Corner

AmeriStaff Nursing Services/YouTube

Types

Blurred Vision (in the Mirror)

Image by noniq

Types of Hypotension

There are several types of hypotension. People who always have low blood pressure have chronic asymptomatic hypotension. They usually have no signs or symptoms and need no treatment. Their low blood pressure is normal for them.

Other types of hypotension occur if blood pressure suddenly drops too low. The signs and symptoms range from mild to severe.

The three main types of this kind of hypotension are orthostatic (OR-tho-STAT-ik) hypotension, neurally mediated hypotension, and severe hypotension linked to shock.

Orthostatic Hypotension

This type of hypotension occurs when standing up from a sitting or lying down position. You may feel dizzy or light-headed, or you may even faint.

Orthostatic hypotension occurs if your body isn't able to adjust blood pressure and blood flow fast enough for the change in position. The drop in blood pressure usually lasts only for a few seconds or minutes after you stand up. You may need to sit or lie down for a short time while your blood pressure returns to normal.

Orthostatic hypotension can occur in all age groups. However, it's more common in older adults, especially those who are frail or in poor health. This type of hypotension can be a symptom of another medical condition. Thus, treatment often focuses on treating underlying conditions.

Some people have orthostatic hypotension, but also have high blood pressure when lying down.

A form of orthostatic hypotension called postprandial hypotension is a sudden drop in blood pressure after a meal. This type of hypotension mostly affects older adults. People who have high blood pressure or a central nervous system disorder, such as Parkinson's disease, also are at increased risk for postprandial hypotension.

Neurally Mediated Hypotension

With neurally mediated hypotension (NMH), blood pressure drops after you've been standing for a long time. You may feel dizzy, faint, or sick to the stomach as a result. NMH also can occur as the result of an unpleasant, upsetting, or scary situation.

NMH affects children and young adults more often than people in other age groups. Children often outgrow NMH.

Severe Hypotension Linked to Shock

Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work well. Blood pressure drops much lower in shock than in other types of hypotension.

Many factors can cause shock. Examples include major blood loss, certain severe infections, severe burns and allergic reactions, and poisoning. Shock can be fatal if it's not treated right away.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (1)

3:49

Types of Hypotension or Low Blood Pressure, Their Symptoms. And How to Manage?

MMAS Health/YouTube

Risk Factors

Medicating High Blood Pressure

Image by TheVisualMD

Who Is At Risk for Hypotension?

Hypotension can affect people of all ages. However, people in certain age groups are more likely to have certain types of hypotension.

Older adults are more likely to have orthostatic and postprandial hypotension. Children and young adults are more likely to have neurally mediated hypotension.

People who take certain medicines—such as diuretics ("water pills") or other high blood pressure medicines—are at increased risk for hypotension. Certain conditions also increase the risk for hypotension. Examples include central nervous system disorders (such as Parkinson's disease) and some heart conditions.

Other risk factors for hypotension include being immobile (not being able to move around very much) for long periods, being out in the heat for a long time, and pregnancy. Hypotension during pregnancy is normal and usually goes away after birth.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (4)

1:35

Why Do I Get Dizzy When I Stand Up? Understanding Orthostatic Hypotension (OH) | TIME

TIME/YouTube

1:28

What can I do to help my low blood pressure while pregnant?

IntermountainMoms/YouTube

3:35

Low Blood Pressure In Pregnancy

Blood Pressure Explained/YouTube

16:40

Pharmacology - Diuretics

Armando Hasudungan/YouTube

Causes

Dehydration

Image by TheVisualMD

What Causes Hypotension?

Conditions or factors that disrupt the body's ability to control blood pressure cause hypotension. The different types of hypotension have different causes.

Orthostatic Hypotension

Orthostatic hypotension has many causes. Sometimes two or more factors combine to cause this type of low blood pressure.

Dehydration (de-hi-DRA-shun) is the most common cause of orthostatic hypotension. Dehydration occurs if the body loses more water than it takes in.

You may become dehydrated if you don't drink enough fluids or if you sweat a lot during physical activity. Fever, vomiting, and severe diarrhea also can cause dehydration.

Orthostatic hypotension also may occur during pregnancy, but it usually goes away after birth.

Because an older body doesn't manage changes in blood pressure as well as a younger body, getting older also can lead to this type of hypotension.

Postprandial hypotension (a type of orthostatic hypotension) mostly affects older adults. Postprandial hypotension is a sudden drop in blood pressure after a meal.

Certain medical conditions can raise your risk of orthostatic hypotension, including:

Heart conditions, such as heart attack, heart valve disease, bradycardia (a very low heart rate), and heart failure. These conditions prevent the heart from pumping enough blood to the body.
Anemia.
Severe infections.
Endocrine conditions, such as thyroid disorders, Addison's disease, low blood sugar, and diabetes.
Central nervous system disorders, such as Parkinson's disease.
Pulmonary embolism.

Some medicines for high blood pressure and heart disease can raise your risk of orthostatic hypotension. These medicines include:

Diuretics, also called "water pills"
Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Nitrates
Beta blockers

Medicines for conditions such as anxiety, depression, erectile dysfunction, and central nervous system disorders also can increase your risk of orthostatic hypotension.

Other substances, when taken with high blood pressure medicines, also can lead to orthostatic hypotension. These substances include alcohol, barbiturates, and some prescription and over-the-counter medicines.

Finally, other factors or conditions that can trigger orthostatic hypotension include being out in the heat or being immobile for a long time. "Immobile" means you can't move around very much.

Neurally Mediated Hypotension

Neurally mediated hypotension (NMH) occurs when the brain and heart don't communicate with each other properly.

For example, when you stand for a long time, blood begins to pool in your legs. This causes your blood pressure to drop. In NMH, the body mistakenly tells the brain that blood pressure is high. In response, the brain slows the heart rate. This makes blood pressure drop even more, causing dizziness and other symptoms.

Severe Hypotension Linked to Shock

Many factors and conditions can cause severe hypotension linked to shock. Some of these factors also can cause orthostatic hypotension. In shock, though, blood pressure drops very low and doesn't return to normal on its own.

Shock is an emergency and must be treated right away. If a person has signs or symptoms of shock, call 9–1–1.

Some severe infections can cause shock. This is known as septic shock. It can occur if bacteria enter the bloodstream. The bacteria release a toxin (poison) that leads to a dangerous drop in blood pressure.

A severe loss of blood or fluids from the body also can cause shock. This is known as hypovolemic (HI-po-vo-LE-mik) shock. Hypovolemic shock can happen as a result of:

Major external bleeding (for example, from a severe cut or injury)
Major internal bleeding (for example, from a ruptured blood vessel or injury that causes bleeding inside the body)
Major loss of body fluids from severe burns
Severe swelling of the pancreas (an organ that produces enzymes and hormones, such as insulin)
Severe diarrhea
Severe kidney disease
Overuse of diuretics

A major decrease in the heart's ability to pump blood also can cause shock. This is known as cardiogenic (KAR-de-o-JEN-ik) shock.

A heart attack, pulmonary embolism, or an ongoing arrhythmia (ah-RITH-me-ah) that disrupts heart function can cause this type of shock.

A sudden and extreme relaxation of the arteries linked to a drop in blood pressure also can cause shock. This is known as vasodilatory (VA-so-DI-la-tory) shock. It can occur due to:

A severe head injury
A reaction to certain medicines
Liver failure
Poisoning
A severe allergic reaction (called anaphylactic (AN-a-fi-LAK-tik) shock)

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (3)

4:33

Low Blood Pressure or Hypotension, Causes, Signs and Symptoms, Diagnosis and Treatment.

Medical Centric/YouTube

42:02

Cardiovascular | Blood Pressure Regulation | Hypotension

Ninja Nerd/YouTube

1:39

Concerns with Low Blood Pressure

Lee Health/YouTube

Symptoms

Depiction of a person feeling dizzy

Image by https://www.myupchar.com

What Are the Signs and Symptoms of Hypotension?

Orthostatic Hypotension and Neurally Mediated Hypotension

The signs and symptoms of orthostatic hypotension and neurally mediated hypotension (NMH) are similar. They include:

Dizziness or light-headedness
Blurry vision
Confusion
Weakness
Fatigue (feeling tired)
Nausea (feeling sick to your stomach)

Orthostatic hypotension may happen within a few seconds or minutes of standing up after you've been sitting or lying down.

You may feel that you're going to faint, or you may actually faint. These signs and symptoms go away if you sit or lie down for a few minutes until your blood pressure adjusts to normal.

The signs and symptoms of NMH occur after standing for a long time or in response to an unpleasant, upsetting, or scary situation. The drop in blood pressure with NMH doesn't last long and often goes away after sitting down.

Severe Hypotension Linked to Shock

In shock, not enough blood and oxygen flow to the body's major organs, including the brain. The early signs and symptoms of reduced blood flow to the brain include light-headedness, sleepiness, and confusion.

In the earliest stages of shock, it may be hard to detect any signs or symptoms. In older people, the first symptom may only be confusion.

Over time, as shock worsens, a person won't be able to sit up without passing out. If the shock continues, the person will lose consciousness. Shock often is fatal if not treated right away.

Other signs and symptoms of shock vary, depending on what's causing the shock. When low blood volume (from major blood loss, for example) or poor pumping action in the heart (from heart failure, for example) causes shock:

The skin becomes cold and sweaty. It often looks blue or pale. If pressed, the color returns to normal more slowly than usual. A bluish network of lines appears under the skin.
The pulse becomes weak and rapid.
The person begins to breathe very quickly.

When extreme relaxation of blood vessels causes shock (such as in vasodilatory shock), a person feels warm and flushed at first. Later, the skin becomes cold and sweaty, and the person feels very sleepy.

Shock is an emergency and must be treated right away. If a person has signs or symptoms of shock, call 9–1–1.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (7)

Orthostatic Hypertension Demonstration

RadioSmith

1:39

Concerns with Low Blood Pressure

Lee Health/YouTube

2:09

Dizziness in pregnancy: All you need to know

BabyCentre/YouTube

1:35

Why Do I Get Dizzy When I Stand Up? Understanding Orthostatic Hypotension (OH) | TIME

TIME/YouTube

1:56

Causes of Fainting | What to Do If Your Child Faints

St. Louis Children's Hospital/YouTube

1:48

Why do people faint | Vasovagal Syncope | Blood phobia | First aid fainting | Free Video lectures

FreeVideoLectures/YouTube

1:28

Dizziness and Fainting During Pregnancy: When to Worry | Parents

Parents/YouTube

Diagnosis

Blood Pressure

Image by TheVisualMD

How Is Hypotension Diagnosed?

Hypotension is diagnosed based on your medical history, a physical exam, and test results. Your doctor will want to know:

The type of hypotension you have and how severe it is
Whether an underlying condition is causing the hypotension

Specialists Involved

A primary care doctor or specialist may diagnose and treat hypotension. The type of specialist most commonly involved is a cardiologist (heart specialist).

Other specialists also may be involved, such as surgeons, nephrologists (kidney specialists), or neurologists (brain and nerve specialists).

Diagnostic Tests

Shock is a life-threatening condition that requires emergency treatment. For other types of hypotension, your doctor may recommend tests to find out how your blood pressure responds in certain situations.

The test results will help your doctor understand why you're fainting or having other symptoms.

Blood Tests

During a blood test, a small amount of blood is taken from your body. It's usually drawn from a vein in your arm using a needle. The procedure is quick and easy, although it may cause some short-term discomfort.

Blood tests can show whether anemia or low blood sugar is causing your hypotension.

EKG (Electrocardiogram)

An EKG is a simple test that detects and records your heart's electrical activity. It shows how fast your heart is beating and whether its rhythm is steady or irregular. An EKG also shows the strength and timing of electrical signals as they pass through each part of your heart.

Holter and Event Monitors

Holter and event monitors are medical devices that record your heart's electrical activity. These monitors are similar to an EKG. However, a standard EKG only records your heartbeat for a few seconds. It won't detect heart rhythm problems that don't occur during the test.

Holter and event monitors are small, portable devices. You can wear one while you do your normal daily activities. This allows the monitor to record your heart for longer periods than a standard EKG.

Echocardiography

Echocardiography (echo) is a test that uses sound waves to create a moving picture of your heart. The picture shows how well your heart is working and its size and shape.

There are several types of echo, including stress echo. This test is done as part of a stress test (see below). Stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary heart disease (also called coronary artery disease).

Stress Test

Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise (or are given medicine if you're unable to exercise) to make your heart work hard and beat fast while heart tests are done.

These tests may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart.

Valsalva Maneuver

This is a simple test for the part of your nervous system that controls functions such as your heartbeat and the narrowing and widening of your blood vessels. If something goes wrong with this part of the nervous system, blood pressure problems may occur.

During this test, you take a deep breath and then force the air out through your lips. You will do this several times. Your heart rate and blood pressure will be checked during the test.

Tilt Table Test

This test is used if you have fainting spells for no known reason. For the test, you lie on a table that moves from a lying down to an upright position. Your doctor checks your reaction to the change in position.

Doctors use a tilt table test to diagnose orthostatic hypotension and neurally mediated hypotension (NMH). People who have NMH usually faint during this test. The test can help your doctor find any underlying brain or nerve condition.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (11)

What is a Stress Test?

Video by Henry Ford Allegiance Health/YouTube

Who Needs a Stress Test?

Video by Mayo Clinic/YouTube

KMH-Holter monitor

Video by KMHCanada/YouTube

What Is a Holter Monitor and How Is It Used for Patients with AFib?

Video by Regional Medical Center of San Jose/YouTube

Valsalva Maneuver

Video by Med School Made Easy/YouTube

The modified Valsalva maneuver - Video Review

Video by Medmastery/YouTube

Tilt Table Testing - Diagnostic Procedure

Video by South Texas Health System/YouTube

What is a tilt table test?

Video by Premier Health/YouTube

Tilt Table Testing (6 of 16)

Video by The Dysautonomia Project/YouTube

Blood Pressure Ranges

High blood pressure, or hypertension, is an important risk factor for strokes and heart attacks. A physician uses a sphygomomanometer to measure a patient's blood pressure by inflating a rubber cuff around his or her arm. The reading is shown on the scale represented in this image. Systolic pressure refers to the pressure in an artery when the heart beats, or contracts. This number is higher than the diastolic pressure, which is occurring when the heart is at rest, between beats. Average blood pressure for adults is 120/80, with the systolic pressure denoted over the diastolic pressure.

Image by TheVisualMD

Cardiac Stress Test

The image shows a patient having a stress test. Electrodes are attached to the patient's chest and connected to an EKG (electrocardiogram) machine. The EKG records the heart's electrical activity. A blood pressure cuff is used to record the patient's blood pressure while he walks on a treadmill.

Image by National Heart Lung and Blood Institute

2:42

What is a Stress Test?

Henry Ford Allegiance Health/YouTube

6:28

Who Needs a Stress Test?

Mayo Clinic/YouTube

4:24

KMH-Holter monitor

KMHCanada/YouTube

0:35

What Is a Holter Monitor and How Is It Used for Patients with AFib?

Regional Medical Center of San Jose/YouTube

3:19

Valsalva Maneuver

Med School Made Easy/YouTube

4:33

The modified Valsalva maneuver - Video Review

Medmastery/YouTube

1:27

Tilt Table Testing - Diagnostic Procedure

South Texas Health System/YouTube

1:33

What is a tilt table test?

Premier Health/YouTube

3:42

Tilt Table Testing (6 of 16)

The Dysautonomia Project/YouTube

Blood Pressure Ranges

TheVisualMD

Cardiac Stress Test

National Heart Lung and Blood Institute

Electrocardiogram

Electrocardiogram

Also called: EKG, ECG

An electrocardiogram (EKG) is a test that measures electrical signals in your heart. An abnormal EKG can be a sign of heart damage or disease.

Electrocardiogram

Also called: EKG, ECG

An electrocardiogram (EKG) is a test that measures electrical signals in your heart. An abnormal EKG can be a sign of heart damage or disease.

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Use the slider below to see how your results affect your health.
Your result is Normal.
EKG results are normal with a consistent heartbeat and rhythm.
Related conditions
An electrocardiogram (EKG) test is a simple, painless, and quick test that records your heart's electrical activity. Each time your heart beats, an electrical signal travels through your heart. The signal triggers your heart's four chambers to contract (squeeze) in the proper rhythm so that your heart can pump blood to your body.
An EKG recording of these signals looks like wavy lines. Your provider can read these lines to look for abnormal heart activity that may be a sign of heart disease or damage.
An EKG can show:
- How fast your heart is beating
- Whether the rhythm of your heartbeat is steady or irregular
- The strength and timing of the electrical signals passing through each part of your heart
Sometimes information from an EKG can help measure the size and position of your heart's chambers.
An EKG is often the first test you'll have if you have signs of a heart condition. It may be done in your provider's office, an outpatient clinic, in a hospital before surgery, or as part of another heart test called a stress test.
An EKG test is also called an ECG. EKG is based on the German spelling, elektrokardiogramm. EKG may be preferred over ECG to avoid confusion with an EEG, a test that measures brain waves.
An EKG test is used to help diagnose and monitor many types of heart conditions and their treatment. These conditions include:
- Arrhythmia
- Cardiomyopathy
- Coronary artery disease
- Heart attack
- Heart failure
- Heart valve diseases
- Congenital heart defects
EKG tests are mainly used for people who have symptoms of a heart condition or have already been diagnosed with a heart condition. They are not generally used to screen people who don't have symptoms unless they have an increased risk of developing heart disease. Your provider can explain your risk for heart disease and let you know if need to have an EKG test. In certain cases, your provider may have you see a cardiologist, a doctor who specializes in heart diseases.
You may need an EKG test if you have symptoms of a heart condition, including:
- Chest pain
- Rapid or irregular heartbeat
- Shortness of breath
- Dizziness
- Fatigue
- A decrease in your ability to exercise
You may also need an EKG to:
- Find out if you had a heart attack in the past but didn't know it
- Monitor your heart if you have a known heart condition
- Check how well your heart treatment is working, including medicine and/or a pacemaker
- Check your heart health:
  Before having surgery
  If you have an increased risk for developing heart disease because:
  Heart disease runs in your family
  You have another condition, such as diabetes, that makes your risk higher than normal
An EKG test only takes a few minutes. It generally includes these steps:
- You will lie on an exam table.
- A provider will place several electrodes (small sensors that stick to your skin) on your arms, legs, and chest. The provider may need to shave body hair to make sure the electrodes stay on.
- The electrodes are attached by wires to a computer or a special EKG machine
- You will lie very still while your heart's electrical activity is recorded on a computer or printed on paper by an EKG machine.
An EKG is a "snapshot" of your heart's activity over a very short time. If you have heart symptoms that come and go, a regular EKG may not catch the problem. In that case, your provider may recommend that you wear a small portable EKG monitor that can record your heart for days or longer while you do your normal activities. You may also need a longer EKG recording if your provider wants to check how well your heart is working after a heart attack or to see if treatment is helping you.
There are many types of long-term EKG monitors. The two main groups are Holter monitors, which can be worn for up to two days, and event monitors, which may record your heart activity for weeks to years depending on the type.
A Holter monitor is about the size of a small camera. You usually wear it on a belt or strap around your neck for a day or two. Wires under your clothes attach to electrodes that stick to your chest. The monitor records your heart's electrical signals the whole time you're wearing it. You may be asked to keep a diary of your symptoms during the test period. After the test period, you remove the monitor and return it according to the instructions. A provider will review the recording of your heart's electrical activity from the monitor.
An event monitor records your heart's electrical activity when you press a button or when the device detects abnormal heart activity. There two main types of event monitors:
- Event monitors that you wear or carry with you. You wear some monitors on your chest or wrist. Other monitors are designed to carry. If you have symptoms, you hold the monitor to your chest. These event monitors may be used for weeks to months. Some of them wirelessly transmit information about your heart to a provider. Others must be returned so a provider can examine the recorded information.
- Event monitors that are inserted under the skin of your chest. These are called implantable event monitors. They are put under your skin during minor surgery that's often done in a doctor's office. These monitors can track your heart's electrical activity for years. You may need this type of EKG monitor if you had a stroke or frequent fainting, and your provider hasn't found the cause. Implantable monitors wirelessly transmit the information they record so your provider can regularly check it.
1. Electrocardiogram: MedlinePlus Medical Test [accessed on Mar 09, 2023]
2. Electrocardiogram: MedlinePlus Medical Encyclopedia [accessed on Feb 04, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (35)

How to Read an Electrocardiogram (ECG): Introduction – Cardiology | Lecturio

Video by Lecturio Medical/YouTube

Major Types of Heart Block

Video by Jeff Otjen/YouTube

How An ECG Works

Video by LivingHealthyChicago/YouTube

This browser does not support the video element.

What are Arrhythmias?

Your heart is electric. In this video you'll see how your heart's electrical system works, and what happens when it malfunctions. Voyage inside the human body as Dr. Mehmet Oz and others explain the dangers of heart arrhythmias, including tachycardia, bradycardia, and atrial fibrillation.

Video by TheVisualMD

12 Lead ECG Explained, Animation

Video by Alila Medical Media/YouTube

Bundle Branch Block, Animation.

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QRS Transitional Zone. See link for real voice update in description!

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ECG Interpretation Basics - ST Segment Changes. See link for real voice update in description!

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Cardiac Axis Interpretation. See link for real voice update in description!

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Electrical system of the heart | Circulatory system physiology | NCLEX-RN | Khan Academy

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Cardiovascular | EKG Basics

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Cardiovascular | EKG's

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Normal sinus rhythm on an EKG | Circulatory System and Disease | NCLEX-RN | Khan Academy

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Cardiac Conduction System and Understanding ECG, Animation.

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Willem Einthoven and the ECG - Stuff of Genius

Video by Stuff of Genius - HowStuffWorks/YouTube

Electrocardiogram (ECG)

A useful tool for determining whether a person has heart disease, an electrocardiogram (ECG) is a test that records the electrical activity of the heart. An ECG, which is painless (no electricity is sent through the body), is used to measure damage to the heart, how fast the heart is beating and whether it is beating normally, the effects of drugs or devices used to control the heart (such as a pacemaker), and the size and position of the heart chambers.

Image by TheVisualMD

Cardiac cycle

Cardiac Cycle vs Electrocardiogram

Image by OpenStax College

Medical Checkups

Image by TheVisualMD

Electrocardiogram

Electrocardiograms (EKGs) are the most commonly given test used to diagnose coronary artery disease. They record the heart's electrical activity and show evidence of angina or heart attack.

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electrocardiogram-illustration made up from Medications

https://pixabay.com/en/electrocardiogram-blood-pressure-ekg-2858693/

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Electrocardiogram

A normal tracing shows the P wave, QRS complex, and T wave. Also indicated are the PR, QT, QRS, and ST intervals, plus the P-R and S-T segments.

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What To Expect After an Electrocardiogram

Normal ECG/EKG complex with labels

Image by Derivative: Hazmat2 Original: Hank van Helvete

Cardiac Stress Test

The image shows a patient having a stress test. Electrodes are attached to the patient's chest and connected to an EKG (electrocardiogram) machine. The EKG records the heart's electrical activity. A blood pressure cuff is used to record the patient's blood pressure while he walks on a treadmill.

Image by National Heart Lung and Blood Institute

Relationship between the Cardiac Cycle and ECG

Initially, both the atria and ventricles are relaxed (diastole). The P wave represents depolarization of the atria and is followed by atrial contraction (systole). Atrial systole extends until the QRS complex, at which point, the atria relax. The QRS complex represents depolarization of the ventricles and is followed by ventricular contraction. The T wave represents the repolarization of the ventricles and marks the beginning of ventricular relaxation.

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The Electric Heart

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Electrocardiogram (EKG)

Electrocardiogram (EKG) is a test used to measure the electrical activity of the heart.

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Comparison of Arrhythmia and Normal ECG

As the muscle tissue in an overstressed heart expands, it tears and scars. The resulting tissue - hardened and marred - does not conduct electricity well. The result is that the system can no longer be relied on to deliver the carefully synchronized pattern of jolts needed to keep the heart pumping smoothly. Doctors call it \"arrhythmia.\" The heart is literally \"skipping a beat.\" This can be measured by an electrocardiogram (ECG). In some cases, arrhythmia can mean simply that the heartbeat is too fast or too slow - a bothersome but not necessarily life-threatening condition. In the worst cases, the arrhythmia indicates a potentially lethal instability in the heart's electric system. The signals that control the heart's contractions get crossed and the heart spasms. If not corrected immediately, this fibrillation of the heart is often fatal. In the U.S., more than 1,000 people die every day from sudden cardiac death, or cardiac arrest.

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Heart Revealing Chamber and Valve

Your heart beats faster or slower depending on information from your brain, which monitors your body's need for blood. However, the basic rhythm of your heart is automatic; it does not depend on signals from your brain. Your heart cells can generate their own electrical signals, which trigger the contractions and cause the entire heart to pump in synchrony. A specialized bundle of muscle and nerve cells called the sinoatrial node (SA node) sits at the top of the right atrium and is the pacemaker of the heart. It generates the signal for the atria to contract and send blood to the ventricles. A similar node - the atrioventricular or AV node - sits at the atrioventricular septum near the bottom of the right atrium and relays the signal from the SA node to the ventricles to contract and pump blood out of the heart. An electrocardiogram (ECG) measures the electrical signals given off by these two nodes and their conduction through the heart. By looking at the frequency and the height of the peaks and valleys of these signals on an ECG, healthcare professionals get a very good idea of how well the electrical system of your heart is working.

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Electrocardigram

An electrocardiogram (EKG) detects and records the heart's electrical activity. When the electrical impulse passes through the atria a small peak is recorded (P), followed by a steep spike as it erupts through the ventricles (R), and then another small peak (T) as the wave passes through and the heart repolarizes (recharges) itself for the next beat.

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Electro- cardiogram

Electrocardiograms, or EKGs, record the electrical activity of the heart. Since injured heart muscle conducts electrical impulses abnormally, the EKG shows if the patient has had or is having a heart attack. It is usually the first test performed.

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SinusRhythmLabels

Schematic diagram of normal sinus rhythm for a human heart as seen on ECG. In atrial fibrillation, however, the P waves, which represent depolarization of the atria, are absent.

Image by Agateller (Anthony Atkielski)

How To Use an Automated External Defibrillator

The image shows a typical setup using an automated external defibrillator (AED). The AED has step-by-step instructions and voice prompts that enable an untrained bystander to correctly use the machine.

Image by National Heart Lung and Blood Institute

Who Needs an Implantable Cardioverter Defibrillator?

Lead II (2) ECG EKG strip of an AICD ICD converting a patient back into thier baseline cardiac ryhthm. The AICD fires near the end of the strip, where the straight line is seen.

Image by Public Domain

Cardiac Cycle

CG Animated Human Heart cut section showing the atria, ventricles and valves, synced with wiggers diagram.

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Mammalian Heart and Blood Vessels

The beating of the heart is regulated by an electrical impulse that causes the characteristic reading of an ECG. The signal is initiated at the sinoatrial valve. The signal then (a) spreads to the atria, causing them to contract. The signal is (b) delayed at the atrioventricular node before it is passed on to the (c) heart apex. The delay allows the atria to relax before the (d) ventricles contract. The final part of the ECG cycle prepares the heart for the next beat.

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9:53

How to Read an Electrocardiogram (ECG): Introduction – Cardiology | Lecturio

Lecturio Medical/YouTube

9:23

Major Types of Heart Block

Jeff Otjen/YouTube

2:45

How An ECG Works

LivingHealthyChicago/YouTube

3:27

What are Arrhythmias?

TheVisualMD

3:27

12 Lead ECG Explained, Animation

Alila Medical Media/YouTube

3:48

Bundle Branch Block, Animation.

Alila Medical Media/YouTube

3:50

QRS Transitional Zone. See link for real voice update in description!

Alila Medical Media/YouTube

1:24

ECG Interpretation Basics - ST Segment Changes. See link for real voice update in description!

Alila Medical Media/YouTube

3:32

Cardiac Axis Interpretation. See link for real voice update in description!

Alila Medical Media/YouTube

9:43

Electrical system of the heart | Circulatory system physiology | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

52:29

Cardiovascular | EKG Basics

Ninja Nerd/YouTube

20:37

Cardiovascular | EKG's

Ninja Nerd/YouTube

8:53

Normal sinus rhythm on an EKG | Circulatory System and Disease | NCLEX-RN | Khan Academy

khanacademymedicine/YouTube

3:45

Cardiac Conduction System and Understanding ECG, Animation.

Alila Medical Media/YouTube

1:46

Willem Einthoven and the ECG - Stuff of Genius

Stuff of Genius - HowStuffWorks/YouTube

Electrocardiogram (ECG)

TheVisualMD

Cardiac cycle

OpenStax College

Medical Checkups

TheVisualMD

Electrocardiogram

TheVisualMD

electrocardiogram-illustration made up from Medications

GDJ

Electrocardiogram

CNX Openstax

What To Expect After an Electrocardiogram

Derivative: Hazmat2 Original: Hank van Helvete

Cardiac Stress Test

National Heart Lung and Blood Institute

Relationship between the Cardiac Cycle and ECG

CNX Openstax

The Electric Heart

TheVisualMD

Electrocardiogram (EKG)

U.S. National Library of Medicine

Comparison of Arrhythmia and Normal ECG

TheVisualMD

Heart Revealing Chamber and Valve

TheVisualMD

Electrocardigram

TheVisualMD

Electro- cardiogram

TheVisualMD

SinusRhythmLabels

Agateller (Anthony Atkielski)

How To Use an Automated External Defibrillator

National Heart Lung and Blood Institute

Who Needs an Implantable Cardioverter Defibrillator?

Public Domain

Cardiac Cycle

DrJanaOfficial/Wikimedia

Mammalian Heart and Blood Vessels

CNX Openstax

Stress Tests

Stress Tests

Also called: Cardiac Stress Test, Cardiac Diagnostic Test

Stress tests shows how well your heart works when it's pumping hard. They can find problems with blood flow to your heart muscle and other heart conditions. Reduced blood flow can be a sign of a serious heart disease.

Stress Tests

Also called: Cardiac Stress Test, Cardiac Diagnostic Test

Stress tests shows how well your heart works when it's pumping hard. They can find problems with blood flow to your heart muscle and other heart conditions. Reduced blood flow can be a sign of a serious heart disease.

Stress tests show how well your heart works when it's pumping hard. Some heart diseases are easier to find when your heart is working its hardest to pump blood through your body. So stress tests check your heart while you exercise on a treadmill or stationary bicycle. If you're not able to exercise, medicine can be used to make your heart work harder , as if you were exercising.
There are different types of stress tests. They all check:
- Blood flow in your heart
- Your blood pressure
- The rate and rhythm of your heartbeat
- The strength of the electrical signals that control your heartbeat
Some stress tests also take pictures of your heart at rest and when it's working hard. The pictures provide more detail about how your heart is working.
Stress tests are most often used to find the cause of symptoms that may be from a heart problem.
The tests can help diagnose certain heart conditions, including:
- Coronary artery disease (CAD)
- Angina
- Arrhythmia
- Heart failure
- Heart valve diseases
- Cardiomyopathy
Stress testing is also used:
- To find out how serious a known heart condition is, including the chance that you'll have a heart attack in the future.
- To help make treatment decisions for a heart condition.
You may need a stress test if you have symptoms that could be from a heart condition. Symptoms may include:
- Chest pain or discomfort without a known cause
- Shortness of breath
- Irregular or rapid heartbeat that may feel like a fluttering in your chest
- Feeling dizzy or lightheaded
You may also need a stress test to check your heart health if you:
- Have a heart condition with new or worsening symptoms.
- Are going to have surgery. Your health care provider may want to see if your heart is strong enough for the operation.
- Are being treated for heart disease. The test can show how much treatment is helping, including heart surgery.
- Have a high risk for heart disease. Your risk may be higher than normal if you have a family history of heart disease and/or certain conditions, such as diabetes, that are linked to heart disease.
- Plan to start an exercise program. If you have a heart condition or a high risk for a heart condition, a stress test can show what level of exercise is safe for you. (Always talk with your provider before starting any strenuous, new exercise.)
Stress tests may be done with or without imaging (pictures of your heart). The most common type of test is an exercise stress test. It doesn't include pictures. But the main steps of an exercise stress test are part of all stress tests:
- You'll have a blood pressure cuff on your arm to check your blood pressure.
- Electrodes will be placed on your body for an electrocardiogram test (also called EKG or ECG). Electrodes are small sensors that stick to your skin. Wires connect the electrodes to a computer or an EKG machine that records the electrical activity in your heart during the stress test.
- If you're unable to exercise: An intravenous (IV) line will be inserted into a vein in your arm. You'll get medicine through the IV. The medicine will make your heart work harder for 10 to 20 minutes while an EKG records your heart's electrical activity. Medicine can be used instead of exercise for all types of stress tests.
- If you can exercise: You'll walk on a treadmill or ride a stationary bicycle. On a treadmill, the speed will slowly increase. The treadmill may also tilt so you feel like you're walking uphill. On a bicycle, the resistance will slowly increase, so it's harder to pedal.
  You'll exercise for about 10 to 15 minutes until you reach a target heart rate based on your age and fitness level. But you may stop the test sooner if:
  
  You develop chest pain, shortness of breath, dizziness, fatigue or other symptoms
  The EKG shows a problem with your heart
- After all types of stress tests, you'll be monitored for 10-15 minutes or until your heart rate returns to normal.
Stress tests with pictures include stress echocardiograms, nuclear stress tests, and cardiac (heart) MRI stress tests. These tests have extra steps:
A stress echocardiogram or "echo" takes moving pictures of your heart using doppler ultrasound. The pictures show the size and shape of your heart and blood flow through your heart. Pictures will be taken before and after your heart has worked its hardest. You'll lie on your left side on a table as a provider moves an ultrasound device on your chest. If you exercise on a bicycle, the second set of pictures may be taken while you're pedaling.
A nuclear stress test takes pictures of your heart using a small amount of a radioactive substance called a "tracer" and a special camera that scans your heart. A provider injects the tracer into your bloodstream through an IV line that's placed in a vein. Your heart and blood vessels absorb the tracer, which makes them show up more clearly in the pictures.
Pictures are taken while you lie on a table before and after your heart has worked its hardest. After the test, the tracer naturally leaves your body in your urine (pee). Drinking lots of water will help remove it faster.
A cardiac MRI stress test takes the most detailed pictures of your heart using radio waves, magnets, and a computer. It is a newer test that's mostly used for very serious heart problems. For an MRI stress test:
- A provider may inject dye into your bloodstream through an IV line placed in your arm. Some cardiac MRIs, but not all, use dye to help show very small details on the pictures.
- Pictures of your heart may be taken before and after your heart has worked hard. To take the pictures, you'll lie on a table that slides into a large, tunnel-like MRI machine. You'll hear loud sounds as the machine takes pictures. If you're exercising for the test, you may use a treadmill near the MRI, or you may exercise while lying in the MRI machine using special devices to move your arms or legs.
1. Stress Tests: MedlinePlus Medical Test [accessed on Mar 09, 2023]

Exercise Tolerance Test

Exercise Tolerance Test

Also called: Treadmill Stress Testing, Exercise Stress Test, Cardiopulmonary Exercise Test, CPX Test

Exercise tolerance testing is a form of cardiac stress testing that uses treadmill exercise with electrocardiogram (EKG) and blood pressure monitoring. The test is used to determine a patient’s functional capacity, assess the probability and extent of coronary artery disease (CAD) as well as assess risks, prognosis and effects of therapy.

Exercise Tolerance Test

Also called: Treadmill Stress Testing, Exercise Stress Test, Cardiopulmonary Exercise Test, CPX Test

Exercise tolerance testing is a form of cardiac stress testing that uses treadmill exercise with electrocardiogram (EKG) and blood pressure monitoring. The test is used to determine a patient’s functional capacity, assess the probability and extent of coronary artery disease (CAD) as well as assess risks, prognosis and effects of therapy.

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Use the slider below to see how your results affect your health.
Your result is Negative.
A normal test is when the blood pressure and heart rate increase appropriately to graded exercise. Some normal physiologic and EKG changes may occur during exercise.
Related conditions
Fatigue, dyspnea, diaphoresis, flushing
Incremental increase in blood pressure and heart rate
Minor EKG changes
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Use the slider below to see how your results affect your health.
-11
5
Your result is Low risk.
Low risk (score > 5) indicates a 5-year survival of 97%. No need for further investigation with coronary angiography.
Related conditions
- Before the test begins, your nurse or doctor will explain it to you. Feel free to ask questions and voice concerns at this time. When you understand what will happen, you will be asked to sign a consent for the test to be performed.
- To monitor your heart during exercise, adhesive patches, called electrodes, will be put on your chest. Your chest will be cleansed with alcohol and shaved in some areas (if necessary) before these electrodes are placed.
- You will be asked about symptoms you have had with exercise in the past. Describe, as completely as you can, any chest discomfort, breathing problems, lightheadedness or dizziness, fluttering in the chest, weakness, fatigue, or anything else you think may be relevant. Also, mention anything you feel while you are being prepared for the test.
- A nurse or doctor will be with you throughout the test. Your heart rate and rhythm and your blood pressure will be checked during the test.
- Generally, the treadmill’s pace and incline will increase every 3 minutes. It is important that you describe anything you feel as you exercise. If you become short of breath, the nurse may ask you to rate it as “mild,” “moderate,” or “severe.” If you have chest discomfort, you will be asked to describe it as best you can and rate it on a scale of 1 to 10 (1 is very mild; 10 is very severe). There is no right or wrong number. This helps your doctor know how you are doing and gives us a better way to compare how you feel before and after the test.
- Keep walking until you are told to stop or until you cannot walk any longer. Let the nurse know when you need to slow down. Keep walk-ing as the treadmill slows. Do not jump off.
- While you rest, your heart will continue to be monitored.
- Inform the doctor or nurse about any temporary or permanent condition that could affect your ability to move, walk, bear weight, or keep your balance. If possible, discuss this when you are first scheduled for the test. It is also important that the doctor and/or nurse conducting the test have this information.
- Carefully follow your doctor’s instructions about medications. Some medications should be stopped for 48 hours before the test; others should not be stopped. If you do not have clear instructions about all your medications (including those for your heart, blood pressure, or other medications), contact your doctor or nurse a few days before the test.
- Avoid caffeine, alcohol, and nicotine 8 hours before the test. Do not eat 2 hours before the test, and do not drink liquids 1 hour before the test. If your exercise test is combined with heart imaging (such as a thallium scan), follow the specific instructions for that test.
- Try to be as well rested as possible. You may need to reschedule the test if you feel unwell (for example, if you have a cold). If you do not feel you can give your maximum exercise effort, contact your nurse or doctor before the test.
- Wear loose, comfortable clothing with a separate top and bottom. Women should wear bras. Wear comfortable, flat shoes that will not slip off while you are walking.
After the procedure:
- You can eat and drink as usual.
- Depending on how you feel, you may go about your normal routine or take it easy if the test tired you.
- Do not take a hot shower for at least an hour after the test. Your blood vessels expand with exercise and need time to return to normal. A hot shower may expand them more, causing low blood pressure and dizziness.
1. Procedures/Diagnostic Tests. Exercise tolerance test. National Institutes of Health Clinical Center. [accessed on Dec 11, 2018]
2. Vilcant V, Zeltser R. Treadmill Stress Testing. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. [accessed on Dec 11, 2018]
3. Am Fam Physician. 2017 Sep 1;96(5):293-299. Exercise Stress Testing: Indications and Common Questions. Garner KK, Pomeroy W, Arnold JJ. [accessed on Dec 11, 2018]
4. Am Fam Physician. 1999 Jan 15;59(2):401-10. Ordering and understanding the exercise stress test. Darrow MD. [accessed on Dec 11, 2018]
5. Harvard Men's Health. Cardiac exercise stress testing: What it can and cannot tell you. [accessed on Dec 11, 2018]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Stress Echocardiography

Stress Echocardiography

Also called: Echocardiography Stress Test, Stress Echo

Stress echocardiography, or echo, is a test that uses sound waves to create moving pictures of your heart. A stress echo is done as part of a stress test. Some heart problems, such as coronary heart disease, are easier to diagnose when the heart is working hard and beating fast.

Stress Echocardiography

Also called: Echocardiography Stress Test, Stress Echo

Stress echocardiography, or echo, is a test that uses sound waves to create moving pictures of your heart. A stress echo is done as part of a stress test. Some heart problems, such as coronary heart disease, are easier to diagnose when the heart is working hard and beating fast.

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Use the slider below to see how your results affect your health.
Your result is Normal.
A normal result means that blood flow through the coronary arteries is probably normal.
Related conditions
1. https://medlineplus.gov/ency/article/007150.htm [accessed on Feb 23, 2022]
2. https://medlineplus.gov/lab-tests/stress-tests/ [accessed on Feb 23, 2022]
3. https://www.nhlbi.nih.gov/health-topics/echocardiography [accessed on Feb 23, 2022]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Blood Pressure Test

Blood Pressure Test

Also called: Blood pressure reading, Blood pressure screening, Systolic (maximum) pressure over diastolic (minimum) pressure

A blood pressure measurement is a test most often used to check for high blood pressure, a common condition that increases the risk for heart disease and stroke. The test can diagnose high blood pressure early, so it can be treated before it causes serious complications.

Blood Pressure Test

Also called: Blood pressure reading, Blood pressure screening, Systolic (maximum) pressure over diastolic (minimum) pressure

A blood pressure measurement is a test most often used to check for high blood pressure, a common condition that increases the risk for heart disease and stroke. The test can diagnose high blood pressure early, so it can be treated before it causes serious complications.

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Use the slider below to see how your results affect your health.
90
121
130
140
Your result is Low.
Some people can naturally have low blood pressure levels. However, in most cases, a BP lower than 90/60 can cause signs and symptoms of hypotension, such as dizziness, lightheadedness, blurry vision, and nausea.
Related conditions
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Use the slider below to see how your results affect your health.
60
81
90
Your result is Low.
Some people can naturally have low blood pressure levels. However, in most cases, a BP lower than 90/60 can cause signs and symptoms of hypotension, such as dizziness, lightheadedness, blurry vision, and nausea.
Related conditions
Each time your heart beats, it pumps blood into your arteries. A blood pressure measurement is a test that measures the force (pressure) in your arteries as your heart pumps. Blood pressure is measured as two numbers:
- Systolic blood pressure (the first and higher number) measures pressure inside your arteries when the heart beats.
- Diastolic blood pressure (the second and lower number) measures the pressure inside the artery when the heart rests between beats.
High blood pressure, also known as hypertension, affects tens of millions of adults in the United States. It increases the risk of life-threatening conditions including heart attack and stroke. But high blood pressure rarely causes symptoms. A blood pressure measurement helps diagnose high blood pressure early, so it may be treated before it leads to serious complications.
A blood pressure measurement is most often used to diagnose high blood pressure.
Blood pressure that's too low, known as hypotension, is much less common. But you may get tested for low blood pressure if you have certain symptoms. Unlike high blood pressure, low blood pressure usually causes symptoms. These include:
- Dizziness or lightheadedness
- Nausea
- Cold, sweaty skin
- Pale skin
- Fainting
- Weakness
A blood pressure measurement is often included as part of a regular checkup. Adults 18 years and older should have their blood pressure measured at least once every two to five years. You should get tested every year if you have certain risk factors. You may be at higher risk if you:
- Are 40 years old or older
- Are overweight or have obesity
- Have a family history of heart disease or diabetes
- Take birth control pills
- Are Black/African American. Black/African Americans have a higher rate of high blood pressure than other racial and ethnic groups
You may need this test if you have symptoms of low blood pressure.
A blood pressure test includes the following steps:
- You will sit in a chair with your feet flat on the floor.
- You will rest your arm on a table or other surface, so your arm is level with your heart. You may be asked to roll up your sleeve.
- Your provider will wrap a blood pressure cuff around your arm. A blood pressure cuff is a strap-like device. It should fit snugly around your upper arm, with the bottom edge placed just above your elbow.
- Your provider will inflate the blood pressure cuff using a small hand pump or by pressing a button on an automated device.
- Your provider will measure the pressure manually (by hand) or with an automated device.
  If manually, he or she will place a stethoscope over the major artery in your upper arm to listen to the blood flow and pulse as the cuff inflates and deflates.
  If using an automated device, the blood pressure cuff automatically inflates, deflates, and measures pressure.
- As the blood pressure cuff inflates, you'll feel it tighten around your arm.
- Your provider will then open a valve on the cuff to slowly release air from it. As the cuff deflates, blood pressure will fall.
- As the pressure falls, a measurement is taken when the sound of blood pulsing is first heard. This is the systolic pressure.
- As the air continues to be let out, the blood pulsing sound will start to go away. When it completely stops, another measurement is taken. This is the diastolic pressure.
This test only takes about one minute to complete.

Your results, also known as a blood pressure reading, will contain two numbers. The top or first number is the systolic pressure. The bottom or second number is the diastolic pressure. High blood pressure readings are also labeled by categories, ranging from normal to crisis. Your reading may show your blood pressure is:

Blood Pressure Category	Systolic Blood Pressure		Diastolic Blood Pressure
Normal	Less than 120	and	Less than 80
High Blood Pressure (no other heart risk factors)	140 or higher	or	90 or higher
High Blood Pressure (with other heart risk factors, according to some providers)	130 or higher	or	80 or higher
Dangerously high blood pressure - seek medical care right away	180 or higher	and	120 or higher

If you've been diagnosed with high blood pressure, your provider may recommend lifestyle changes and/or medicines to control your blood pressure. Your provider may also recommend that you regularly check your blood pressure at home with an automated blood pressure monitor. An at-home blood pressure monitor usually includes a blood pressure cuff and a digital device to record and display blood pressure readings.

Home monitoring is not a replacement for regular visits to your provider. But it can provide important information, such as whether treatment is working or your condition may have worsened. Also, home monitoring may make the test less stressful. Many people get nervous about getting their blood pressure taken at a provider's office. This is called "white coat syndrome." It can cause a temporary rise in blood pressure, making the results less accurate. For more information about home monitoring of blood pressure, talk to your provider.

If you were tested for low blood pressure, a blood pressure reading of 90 systolic, 60 diastolic (90/60) or lower is considered abnormal. Treatments for low blood pressure may include medicines and making certain changes to your diet.

If you were diagnosed with high blood pressure, your provider may recommend one or more of the following lifestyle changes.
- Exercise regularly. Staying active can help lower your blood pressure and also help manage your weight. Most adults should aim for 150 minutes of physical activity per week. Check with your provider before beginning an exercise program.
- Keep a healthy weight. If you are overweight, losing as little as 5 pounds can lower your blood pressure.
- Eat a healthy diet that includes fruits, vegetable, and whole grains. Limit foods high in saturated fat and total fat.
- Reduce salt in your diet. Most adults should have less than 1500 mg of salt per day.
- Limit alcohol use. If you choose to drink, limit yourself to one drink a day if you are a woman; two drinks a day if you're a man.
- Don't smoke.
1. https://www.cdc.gov/bloodpressure/measure.htm [accessed on Mar 24, 2019]
2. https://www.nhlbi.nih.gov/health-topics/high-blood-pressure [accessed on Mar 24, 2019]
3. https://www.nhlbi.nih.gov/node/80139 [accessed on Mar 24, 2019]
4. https://www.nia.nih.gov/health/high-blood-pressure [accessed on Mar 24, 2019]
5. https://newsinhealth.nih.gov/2018/01/experts-lower-high-blood-pressure-numbers [accessed on Mar 24, 2019]
6. https://newsinhealth.nih.gov/2016/01/blood-pressure-matters [accessed on Mar 24, 2019]
7. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-blood-pressure-in-adults [accessed on Mar 27, 2019]
8. https://www.acc.org/latest-in-cardiology/articles/2017/11/14/14/42/the-2017-high-blood-pressure-guideline-risk-reduction-through-better-management [accessed on Mar 27, 2019]

Additional Materials (50)

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What is Blood Pressure?

Blood pressure is stated as two numbers that represent the highest and lowest pressure your heart attains during a single beat. The first or top number represents the pressure when your heart contracts: the systolic pressure. The second or bottom number represents the pressure when your heart rests between beats: the diastolic pressure.

Video by TheVisualMD

This browser does not support the video element.

What is Hypertension?

Go deep inside the human body to understand how your blood pressure works, as you travel into the vessels to see the damage that high blood pressure leaves in its wake. Listen to some of the world's top doctors, including renowned cardiologist Mehmet Oz, talk about why hypertension is "the silent killer" and how you can defend yourself against it.

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SPRINT Participant Has Blood Pressure Measured

In this image: Mr. Curtis Minor, 58 year old AA Male who is taking part in the SPRINT study at Downtown Health Plaza with Miriam Baird, RN. A major NIH-funded clinical trial has discovered nuanced evidence linking brain and vascular health.

Image by National Institutes of Health (NIH)

Man getting Blood Pressure Reading

Some risk factors for prostate cancer are controllable, some aren't. Knowing what the risk factors are can help you to lower your chances of getting prostate cancer and to make decisions about beginning screening.

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Doctor Taking Woman's Blood Pressure

This image shows a female patient having blood pressure read by a male doctor and by using a blood pressure cuff in a clinical setting. Hypertension is often referred to as the \"silent killer,\" because it can cause no symptoms and go undetected for years. And as hypertension goes undiagnosed, the delicate linings of your blood vessels are being damaged, particularly those of the heart, the kidneys, and the eyes. Hypertension is another word for high blood pressure; it has nothing to do with whether a person is considered tense or high-strung. Blood pressure is the measurement of the force the blood exerts as it pushes against the walls of your arteries. Your blood pressure is measured by a blood pressure cuff that is wrapped around your upper arm. Originally the readings referred to the height of a displaced column of mercury, but as in thermometers, the mercury yardstick is giving way to digital technologies. The \"top\" or first number-systolic pressure-represents the blood's pressure as the heart is contracted. The \"bottom\" or second number-diastolic pressure-represents the blood's pressure in the vessels when the heart is relaxed. Normal blood pressure is in the range of 120 (systolic) over 70 (diastolic).

Image by TheVisualMD

Blood Pressure

Taking a person's blood pressure

Image by BruceBlaus

Blood Pressure

Blood pressure is stated as two numbers that represent the highest and lowest pressure your heart attains during a single beat. The first or top number represents the pressure when your heart contracts: the systolic pressure. The second or bottom number represents the pressure when your heart rests between beats: the diastolic pressure.

Image by TheVisualMD

Blood Pressure Ranges

High blood pressure, or hypertension, is an important risk factor for strokes and heart attacks. A physician uses a sphygomomanometer to measure a patient's blood pressure by inflating a rubber cuff around his or her arm. The reading is shown on the scale represented in this image. Systolic pressure refers to the pressure in an artery when the heart beats, or contracts. This number is higher than the diastolic pressure, which is occuring when the heart is at rest, between beats. Average blood pressure for adults is 120/80, with the systolic pressure denoted over the diastolic pressure.

Image by TheVisualMD

Man with Visible Brain and Heart

The most obvious way in which your body manages blood flow and pressure is to change the heart rate. When the pulse rate goes up, in general, the pressure in the system goes up, which in turns drives the blood around the body more quickly. The blood vessels themselves also play an important role in pressure-management. Blood vessels are \"living pipes\". They're elastic and flexible and have special sensors called baroreceptors that monitor the ebb and flow of blood. Baroreceptors are actually nerve bundles that provide immediate feedback to the brain. With this information and depending on the needs of the moment, the arteries dilate and contract to help propel blood through the system. Blood can be diverted to muscles during exercise, for example, or away from the skin during cold weather to avoid heat loss. The arteries can contract to prevent blood loss due to injury or dilate to flood the face for that telling blush.

Image by TheVisualMD

Arm with Blood Pressure Cuff

This diagram represents the number of individuals affected with hypertension. The American Heart Association estimates that nearly one-third of Americans have hypertension.

Image by TheVisualMD

Keeping Blood Pressure Healthy

Image by TheVisualMD

Medicating High Blood Pressure

If lifestyle changes don’t reduce blood pressure to an acceptable level, doctors will generally prescribe antihypertensive medications. There are a number of different types of antihypertensives available. The most commonly prescribed include: Thiazide diuretics. Often the first drug prescribed, diuretics dilate blood vessels and also decrease fluid volume in the body by helping the kidneys to eliminate salt and water. Angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitors reduce hypertension by dilating arterioles (the smallest divisions of the arteries, linking the arteries and the capillaries). They do this by blocking the production of ACE, a naturally occurring substance that constricts blood vessels. Angiotensin II receptor blockers (ARBs). Like ACE inhibitors, ARBs dilate arterioles, but they accomplish this by preventing ACE from having any effect on the heart and blood vessels. ARBs are often prescribed for people who experience adverse side effects from ACE inhibitors.

Image by TheVisualMD

2:46

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What is Hypertension?

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How blood pressure works - Wilfred Manzano

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The Heart, Part 2 - Heart Throbs: Crash Course A&P #26

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Tilt-Table Test

Tilt-Table Test

Also called: Tilt Table Test

A tilt-table test measures your blood pressure and heart rate as you change your posture and position. The test is used to evaluate the cause of unexplained fainting.

Tilt-Table Test

Also called: Tilt Table Test

A tilt-table test measures your blood pressure and heart rate as you change your posture and position. The test is used to evaluate the cause of unexplained fainting.

{"label":"Tilt-Table Test Reference Range","scale":"lin","step":0.25,"hideunits":true,"items":[{"flag":"negative","label":{"short":"Negative","long":"Negative","orientation":"horizontal"},"values":{"min":0,"max":1},"text":"A negative result means that there were no signs of a condition that causes an abnormal change in your blood pressure, heart rate or heart rhythm.","conditions":[]},{"flag":"positive","label":{"short":"Positive","long":"Positive","orientation":"horizontal"},"values":{"min":1,"max":2},"text":"A positive result means you may have a condition that causes an abnormal change in blood pressure, heart rate or heart rhythm.","conditions":["Autonomic neuropathy","Bradycardia","Heart arrhythmia","Low blood pressure (hypotension)","Multiple system atrophy (MSA)","Orthostatic hypotension (postural hypotension)","Tachycardia","Vasovagal syncope"]}],"value":0.5}[{"negative":0},{"positive":0}]
Use the slider below to see how your results affect your health.
Your result is Negative.
A negative result means that there were no signs of a condition that causes an abnormal change in your blood pressure, heart rate or heart rhythm.
Related conditions
1. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/tilt-table-test [accessed on Mar 18, 2019]
2. https://www.mayoclinic.org/tests-procedures/tilt-table-test/about/pac-20395124 [accessed on Sep 24, 2021]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

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Autonomic Test - About your Mayo Clinic Test

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Tilt Table Testing - Diagnostic Procedure

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Treatment

Fluid Filtration

Image by TheVisualMD

How Is Hypotension Treated?

Treatment depends on the type of hypotension you have and the severity of your signs and symptoms. The goal of treatment is to bring blood pressure back to normal to relieve signs and symptoms. Another goal is to manage any underlying condition causing the hypotension.

Your response to treatment depends on your age, overall health, and strength. It also depends on how easily you can stop, start, or change medicines.

In a healthy person, low blood pressure without signs or symptoms usually isn't a problem and needs no treatment.

If you have signs or symptoms of hypotension, you should sit or lie down right away. Put your feet above the level of your heart. If your signs or symptoms don't go away quickly, you should seek medical care.

Orthostatic Hypotension

Many treatments are available for orthostatic hypotension. If you have this condition, your doctor may advise making lifestyle changes, such as:

Drinking plenty of fluids, such as water or sports drinks that contain nutrients like sodium and potassium.
Drinking little or no alcohol.
Standing up slowly.
Not crossing your legs while sitting.
Slowly increasing the amount of time you sit up if you've been immobile for a long time because of a medical condition. The term "immobile" refers to not being able to move around very much.
Eating small, low-carbohydrate meals if you have postprandial hypotension (a form of orthostatic hypotension).

Talk with your doctor about using compression stockings. These stockings apply pressure to your lower legs. The pressure helps move blood throughout your body.

If medicine is causing your low blood pressure, your doctor may change the medicine or adjust the dose you take.

Several medicines are used to treat orthostatic hypotension. These medicines, which raise blood pressure, include fludrocortisone and midodrine.

Neurally Mediated Hypotension

If you have neurally mediated hypotension (NMH), you may need to make lifestyle changes. These may include:

Avoiding situations that trigger symptoms, such as standing for long periods. Unpleasant, upsetting, or scary situations also can trigger symptoms.
Drinking plenty of fluids, such as water or sports drinks that contain nutrients like sodium and potassium.
Increasing your salt intake (as your doctor advises).
Learning to recognize symptoms that occur before fainting and taking action to raise your blood pressure. For example, sitting down and putting your head between your knees or lying down can help raise blood pressure.

If medicine is causing your hypotension, your doctor may change the medicine or adjust the dose you take. He or she also may prescribe medicine to treat NMH.

Children who have NHM often outgrow it.

Severe Hypotension Linked to Shock

Shock is a life-threatening emergency. People who have shock need prompt treatment from medical personnel. If a person has signs or symptoms of shock, call 9–1–1 right away.

The goals of treating shock are to:

Restore blood flow to the organs as quickly as possible to prevent organ damage
Find and reverse the cause of shock

Blood or special fluids are put into the bloodstream to restore blood flow to the organs. Medicines can help raise blood pressure or make the heartbeat stronger. Depending on the cause of the shock, other treatments—such as antibiotics or surgery—may be needed.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (4)

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How can you increase blood pressure if you have hypotension?

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Hypotension. How to raise low blood pressure immediately and naturally

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6:31

Worried about your low blood pressure?

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Water at Work

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Living With

A woman has her blood pressure taken

Image by U.S. Air Force photo by Staff Sgt. Christopher Gross

Living With Hypotension

Doctors can successfully treat hypotension. Many people who had the condition and were successfully treated live normal, healthy lives.

If you have hypotension, you can take steps to prevent or limit symptoms, such as dizzy spells and fainting.

If you have orthostatic hypotension, get up slowly after sitting or lying down, or move your legs before changing your position. Eat small, low-carbohydrate meals if you have postprandial hypotension (a form of orthostatic hypotension).

If you have neurally mediated hypotension, try not to stand for long periods. If you do have to stand for a long time, move around and wear compression stockings. These stockings apply pressure to your lower legs. The pressure helps move blood throughout your body.

Drink plenty of fluids, such as water or sports drinks that contain nutrients like sodium and potassium. Also, try to avoid unpleasant, upsetting, or scary situations. Learn to recognize symptoms and take action to raise your blood pressure. Children who have NMH often outgrow it.

Other lifestyle changes also can help you control hypotension.

Ask your doctor about learning how to measure your own blood pressure. This will help you find out what a normal blood pressure reading is for you. Keeping a record of blood pressure readings done by health providers also can help you learn more about your blood pressure.

Severe hypotension linked to shock is an emergency. Shock can lead to death if it's not treated right away. If you see someone having signs or symptoms of shock, call 9–1–1.

Signs and symptoms of shock include light-headedness, sleepiness, and confusion. Over time, as shock worsens, a person won't be able to sit up without passing out. If the shock continues, the person can lose consciousness.

Other signs and symptoms of shock include cold and sweaty skin, a weak and rapid pulse, and rapid breathing.

Source: National Heart, Lung, and Blood Institute (NHLBI)

Additional Materials (1)

4:42

5 Easy Ways To Increase Low Blood Pressure (Hypotension)

Dr Sam Robbins/YouTube

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