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Updated: May 8, 2025
During an intermittency of the pulse from a weak or intermittently acting ventricle, the diastolic pressure will reach its lowest point, and in auricular fibrillation the pressure pulse from the highest systolic to the lowest diastolic may be very great. In arteriosclerosis the systolic may be high, and the diastolic low, and hence a large pressure pulse.
If there is a low systolic pressure and a high diastolic pressure, this shows impairment of the heart, whether or not any other organic lesion is present. Generally speaking, a low systolic pressure shows a weak acting heart muscle, and a very low diastolic pressure shows a dilated condition of the arterioles.
In cardiac failure, as the systolic pressure falls the diastolic is likely to be increased, and the pressure pulse thus diminishing, allows insufficient blood to go to the medullary centers, and death soon occurs. Therefore, in acute illnesses a sustained pressure pulse gives a better prognosis than a diminishing pressure pulse.
The symptoms of heart strain, if the condition is acute, are those of complete prostration, lowered blood pressure, and a sluggishly, insufficiently acting heart. The heart is found enlarged, the apex beat diffuse and there may be a systolic blow at the mitral or tricuspid valve.
The diastolic pressure is not much affected by food. This increased systolic pressure is the greatest about half an hour after a meal, and then gradually declines until the next meal. Any active, hustling man, or a man under strain, has a rise of blood pressure during that strain, especially notable with surgeons during operation, or with brokers or persons under high nervous tension.
However, it should be again urged in making insurance examinations that psychic disturbance or mental tensity very readily raises the systolic pressure. MacKenzie believes that a diastolic pressure over 100 under the age of 40 is abnormal, and anything over the 110 mark above that age is certainly abnormal. Int.
Of course systolic murmurs may be due to a disturbed condition of the blood, but if they occur with the above-mentioned symptoms and signs, endocarditis should be diagnosed. If the heart becomes seriously weak and the patient suffers much dyspnea, myocarditis should be known to be present with the endocarditis.
Not infrequently soft systolic murmurs are heard at the pulmonary and tricuspid valves during acute endocarditis. It is rare, however, that these valves are so affected during childhood or adult life as to be permanently disabled. Whether a diminished alkalinity of the blood in rheumatism has anything to do with the cause of the frequent complication of endocarditis has not been determined.
The patient, being at rest and removed as far as possible from all excitement, may be conversed with to take his mind away from the fact that his blood pressure is being taken. He also should not watch the dial, as any tensity on his part more or less raises the systolic pressure, the diastolic not being much affected by such nervous tension.
Of course it should be recognized that the systolic pressure thus obtained will generally be some millimeters above that obtained with the finger, perhaps the average being equivalent to about 5 mm. of mercury. The diastolic pressure will often range from 10 to 15 mm. below the reading obtained by other methods.
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