(Total side note, docs don’t typically crack open chests to put in stents. It’s typically a simple procedure done while mostly awake through your radial or femoral artery with a poke not much more than a blood draw needle.)
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Just chiming in here as a health care professional.
The manual cuff with stethoscope will be the most accurate way to take a BP. This is assuming that the clinician has good technique with cuff placement and good hearing. (Although we also watch the needle on the gauge move) The start of the beating is the systolic or top number and the end of the beating is the diastolic number.
A digital arm cuff is generally pretty accurate for most people. There are exceptions including persons with arrhythmia such as AFib or persons with tremors such as with Parkinson’s disease. The digital cuff does not always differentiate between a muscle movement and a pulse at the sensor. It also frequently gives an error for very low BP readings.
The wrist cuff is the least accurate however can be very useful for home use especially if a person cannot apply an arm cuff independently (stroke patients for example) For some people it is actually quite accurate and is at least generally able to show a net change that should be checked out. We also often use it with patients with severe dementia because they can be very resistant to any compression on their arm.
Hope this helps. 
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There might be something to it as yesterday I had an outpatient procedure that involved fasting and reduced water intake and my BP was low, even for me. I’m talking, like 94/49. I’m usually 106/72. The nurse said the low reading was likely from dehydration.
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Curious - why is it important to share more than once that the doc was French Canadian?
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Me too! I keep a log at home now. No matter how much I try to zen at the office, the BP is high. Years ago, it was real low.
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I don’t measure my blood pressure out of the doctor’s office, so I don’t have a good sense of how elevated above base level it is at doctor’s office. I measured 95/62 at my last doctor’s visit, so the potential concern would be too low rather than too high.
However, I do measure my resting heart rate at home – both manually and via my Fitbit. Both show a RHR near ~40 under true rest conditions at home, while I’m closer to 50 in a typical doctor’s visit. If I measured 40 in doctor’s office, I suspect I’d be flagged as too low (before I mentioned my athletic training/history), but 50 does not get flagged.
Will the automated cuffs be accurate for PVCs? Not for the pulse obviously but for the BP itself?
You and I have the same veins. Ugh. When I need an IV, I always ask for their most experienced person to get the needle in. EVERY TIME, they smile and have the regular person try. And try. And try. Then they apologize and go get the experienced person. Before my last colonoscopy, I called the office and even wrote an email explaining this. And guess what? Same thing! After that, I wrote a bad review for them. I don’t say “That’s OK” anymore when they apologize. It’s not.
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Generally yes. But it would depend on the frequency of the PVCs.
If someone is having PVCS, I would recommend taking a couple of BP readings and taking an average. If readings are within 10 points for back to back readings, probably ok. But if in doubt, take your digital machine to a medical appointment and have the med assistant or nurse take a manual reading and then check with your cuff.
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Thanks!
I’ve always been borderline low but recent readings have been high (for me) at the clinic . Was hoping to blame the PVCs! I guess i should start tracking it at home to see if it’s consistent.
I was a lab tech during undergrad and grad school. I was applying for a part time, bilingual medical assistant job for a female medical practice. I was trained by a female gynecologist and she just so happened to be the medical director. She was a former instructor at the medical school at the local UC.
She told me that she was impressed with my ability to retain and recall information quickly, as well as my care of the patients so she wanted to personally train me. She personally supervised me for two years in how to do lab work, vitals and other “fun” but messy, clinical skills (centrifuging fluids, autoclaving lots and lots of instruments, etc.).
She was extremely strict on blood pressure. Over and over again, she would state “remember you cannot diagnose someone with a high blood pressure, unless you have attempted that blood pressure in three different settings, and three different environments.”
One of them would be in a soft lit room. Another would be a patient lying down. Another would be midmorning appointments for women who worked. As a last resort and rarely, she would personally go to a patient’s home to take the blood pressure.
She showed me how the ambient environment vastly and, specifically, affected women with high blood pressure readings.
She also showed me how to take a blood pressure so that I didn’t have to go as high on the sphygmomanometer (Mercury) to get an accurate blood pressure reading. Everyone was different in the amount of air, in the cuff, needed to cease the blood pressure flow.
If the systolic reading was above 140-200 and the diastolic was at 90, I would immediately tell the patient that the blood pressure was running high, but that I couldn’t say that she had actually had “high blood pressure” because there were lots of factors affecting the BP. Also, that the physician would immediately address it. If the patient was really concerned, and would push me to say why I thought it was high, I would pull out my worn, laminated copy of “What is blood pressure?”, and tell her “I’m not a physician but a lot of factors affect blood pressure. Here’s a list of things that may affect it. Please ask the physician when you’re in the exam room.”
When I was younger my blood pressure ranged from 90/60 to ~110/70. During my pregnancies, I had toxemia and became grossly overweight. I was placed on blood pressure medication. I still take blood pressure medication and it rarely runs above 120/80. I know immediately if my blood pressure runs high during an exam visit. It rarely does.
As a reminder, you can always demand they do a manual pressure only and not use the automated machine. Ensure legs are not crossed and feet on the floor. Be sure to wear layered clothing and insist they do the blood pressure on your bare arm, not over clothing. Also, ensure they are using the correct sized cuff for your arm.
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Yes, we always have to have one of the smaller cuffs and be sure to rest our arm. My BP is nearly always low or very low. Sometimes I’m given water to drink and then they take it again. Normally I’m not dizzy though and my heart rate is high.
I’m in a clinical trial for an eye medication. Every 4 weeks I go to the retinologist and have to do blood draws and once (so far) had to have a dye injected. The person I work with most wanted to do the first blood draw and then the dye injection. Blood draw didn’t go well as she was moving the needle around, etc and causing bruising (if you call a plum sized black and blue mark 'bruising). I showed them. I said “i’m dizzy” and then I threw up, then there were 4 people in the room trying to help. I went into Princess Mode, demanded more water, cooling off. They had to ask the doctor if it was okay to continue. A more experienced person did the dye insertion, but of course they were all concerned about my fainting so kept asking if I was okay. JUST DO IT.
The two bruises were HUGE, and lasted 2.5 weeks.
Then I went to an oncology appt where the blood draw was almost perfect but because they did that, then I had appt, they had to do another, the 2nd draw caused the first to ‘bubble’ and yes, another bruise.
Monday back to the retinologist so yes, I’ll have another bruise. Long sleeve season coming soon.
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I do my cuff BP/pulse/blood sugars every morning. I don’t think the cuff is very accurate as it jumps all over the place but if it is very high, I try to stay still for awhile and usually it goes down.
Today blood sugar was sky high. I couldn’t figure out why thinking about everything I ate yesterday but nothing unusual. I worried for an hour and took it again (nothing eaten in that hour) and it was back to normal. I’m wondering if the battery is low, but there is no light indicating that.
This medical routine is going to kill me.