Thursday, 26 July 2012

YOUR HEALTH Dr James Le Fanu: 27 July

Yes, your blood pressure can be too low, the problems of internet diagnoses, and what causes ‘over inflated’ lungs

Written by Dr James Le Fanu
Wallis Simpson once famously observed that you could never be 'too rich or too thin' – and so too with blood pressure, where the prevailing view would be that it can never be too low. But this is not necessarily the case, as a 75-year-old reader from Suffolk discovered when, after feeling a bit dizzy and breathless on exertion, she collapsed while visiting Cambridge to watch her granddaughter row on the river. She was whisked off to Addenbrooke's Hospital where, despite lots of tests over the next 10 days, nothing was found other than 'anxiety and very minor heart defects' for which she required no specific treatment.

Then, she says, she had a stroke of luck. Her local vicar (a retired anaesthetist) while in conversation with his churchwarden (her husband) learnt of her symptoms and, recognising there was probably something seriously amiss, advised a second opinion at London's St Bartholomew's Hospital. As the vicar had suspected, she had Addison's disease, where the adrenal glands fail to produce sufficient amounts of the hormone aldosterone, resulting in... low blood pressure, dizziness and breathlessness on exertion.

Further, it is interesting to note that the prevailing view of 'the lower the blood pressure the better' is not universal. Doctors in France and Germany in particular maintain it can be a cause of many common complaints, such as mental and physical tiredness, fainting and even depression. This would seem to be confirmed by medical studies involving measuring the blood pressure in thousands of people, which consistently reveal that those in whom it is on the low side are much more likely to report such non-specific symptoms.

It is not possible to come to a firm conclusion about this, but it is certainly the case that those taking medication for hypertension who start feeling faint or dizzy are almost certainly being over-treated, warranting a judicious reduction in the dosage of their medication.

This week's medical problem comes courtesy of a lady from Bristol whose chest X-ray, requested by her family doctor for a chronic cough, showed her lungs to be 'over inflated'. She is a bit puzzled by this as she has no breathing difficulties, does not have asthma and has never smoked. What might be going on?

This finding of inflated lungs is strongly suggestive of the condition emphysema, where the air sacs in the lungs break down to form large cysts or bullae. Still, the risk of emphysema in non-smokers is very low, which might suggest perhaps some other explanation, such as the genetic condition Alpha 1-antitrypsin deficiency, due to the absence of a vital protein for maintaining the structure of the lung. This needs further clarification, warranting referral to the chest clinic at her local hospital, for a specialist opinion.




The plethora of information available on the internet on every medical condition necessarily raises the question of how accurate it might be. Dr David Hart, attached to the London School of Medicine, writing in the British Medical Journal, reports when searching for information on the bleeding condition haemophilia that Wikipedia (predictably) proved to be the most consistently featured source – but interestingly none of those contributing to this site were 'experts' in the condition.

This does not mean that the content is necessarily misleading but would suggest that people should perhaps spread their 'net' (as it were) rather more widely. The best of all sites on medical matters is which is both immensely authoritative and features interviews with those affected by the condition, providing an invaluable patients' perspective.

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