Left Arm Blood Pressure Research Articles

Upper extremity pain of 10 years duration caused by a glomus tumor

Long-standing limb pain typically has a multifactorial etiology not amenable to causal therapy. We present a case of chronic progressing upper extremity pain caused by a glomus tumor; the excision was curative. A 39-year-old woman presented with 10-year history of constant deep internal throbbing, aching pain localized to the radial aspect of the left index finger and additional intermittent shooting pains radiating up the arm toward the shoulder. Pain was increased after minor local trauma, following cold exposure, and for unknown reasons. A blotchy, bluish skin discoloration could appear on the radial aspect of the index finger during severe pain. Nonsteroidal antinflammatory drugs, narcotics, amitriptyline, local heat, bracing, and a sympathetic nerve block had all been ineffective. The physical examination was characterized by exquisite pressure tenderness over the radial aspect of the left index finger, most pronounced just distal to the distal interphalengeal joint. Inflation of a left arm blood pressure cuff to above systolic pressures abolished pain. A glomus tumor was suspected and confirmed by histologic examination. Glomus tumors are rare, benign neoplasms (1 to 5% of all hand tumors), developing from neuromyoarterial glomus bodies. They usually present with pain and may mimic other painful conditions, delaying the average time until diagnosis for up to 10 years. The classic diagnostic triad consists of local pain, pressure tenderness, and cold hypersensitivity. Abolition of pain following inflation of a blood pressure cuff to above systolic levels (ischemia test) is highly diagnostic. We suggest routine use of this test in cases of upper limb pain of unclear etiology.

Percutaneous Transluminal Stent Placement to Treat Subclavian Steal Syndrome

To describe nonsurgical stent placement to treat subclavian steal syndrome after failure of traditional balloon angioplasty. Seven patients with subclavian steal syndrome underwent diagnostic angiography, which showed four stenoses and three occlusions of the proximal left subclavian artery. Most patients presented with vertigo, left arm claudication, or syncope. Initial balloon angioplasty failed; there was elastic recoil with more than 30% residual stenosis or subintimal dissection. The three occlusions were treated with urokinase pulse-spray thrombolysis. All seven patients then underwent stent placement. Initial technical success was achieved in all seven cases (100%), with an average right versus left arm blood pressure gradient of 0 mm Hg (-11 to 12 mm Hg) at mean follow-up of 12 months (4-24 months) (positive gradient = systolic pressure of right arm > that of left arm; negative gradient = systolic pressure of left arm > that of right arm). Symptoms of arm claudication and syncope resolved, and vertigo improved or resolved after the procedure. There were no deaths, strokes, or emboli in the perioperative or follow-up period. Percutaneous transluminal stent placement may be an effective treatment of subclavian steal syndrome in patients with lesions that are refractory to traditional angioplasty.

Right- and Left-arm Blood Pressure Discrepancies in Vascular Surgery Patients

To identify a relationship between atherosclerotic vascular disease and differences in blood pressure between the right and left arms, blood pressure differences between arms were measured in patients with peripheral vascular disease (PVD, n = 58), in patients with coronary artery disease (CAD, n = 38), and in patients with no evidence of atherosclerotic disease, who served as a control group (n = 38). The incidence and magnitude of right and left arm pressure difference determined by the oscillometric technique were compared between the patient groups. The incidence of systolic pressure difference greater than or equal to 20 mmHg between arms in patients with PVD (21%) was greater than that in either those with CAD (3%) (P less than or equal to 0.05) or control subjects (0%) (P less than 0.01). The incidence of systolic pressure difference greater than or equal to 45 mmHg between arms in patients with PVD (10%) was greater than that in either those with CAD (0%) (P less than 0.05) or control subjects (0%) (P less than 0.05). Patients with PVD also had a greater incidence of right and left arm difference than did those with CAD or controls for mean and diastolic blood pressures. Of all patients with a systolic difference greater than 10 mmHg, neither the right nor the left arm blood pressure was consistently higher: 21 of 35 (60%) had a higher pressure in the right arm, and 14 of 35 (40%) had a higher pressure in the left arm (P = 0.33). Gender, diabetes, hypertension, smoking, and age were not associated with a difference in blood pressure between the right and left arms.(ABSTRACT TRUNCATED AT 250 WORDS)

Subclavian stenosis presenting as progressive exertional angina pectoris

Left subclavian stenosis is an uncommon cause of exertional left arm pain. In a patient who presented with exertional chest and left arm pain in an increasing pattern, clinical evaluation disclosed a discrepancy between right and left arm blood pressure. Exercise stress testing with thallium revealed normal myocardial perfusion. Aortic arch and selective angiography revealed a high-grade proximal left subclavian stenosis. Subclavian angioplasty was performed with complete resolution of symptoms. This case demonstrates that ischemic left arm pain due to subclavian stenosis can present as accelerated angina, and highlights the importance of determining blood pressure in both arms in routine evaluation of patients at risk for atherosclerosis.