When is low blood pressure an emergency?

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Low blood pressure is a common problem, but many people don’t understand when low blood pressure is an emergency. In the last 15 years, I have treated thousands of patients hospitalized with low blood pressure. Some of these patients would have done better if they had recognized the medical emergency associated with low blood pressure symptoms and went to the ER earlier than they did.

I have written this article based on my personal experience as well as a thorough review of relevant medical literature. After reading this article, you will clearly understand these points:

  1. What diseases and conditions associated with low blood pressure are truly life-threatening emergencies
  2. The symptoms of low blood pressure associated with each of the six life-threatening conditions
  3. What to expect when hospitalized with low blood pressure associated with a true medical emergency

Diseases and conditions when low blood pressure means a medical emergency

When you have low blood pressure after any of the following medical events, it is a true medical emergency. If you have a blood pressure machine at home and can check your blood pressure quickly, you can make sure your blood pressure is actually low. However, if you have symptoms of low blood pressure along with symptoms of any of these conditions listed below, do not rely on a home blood pressure machine. You need to call 911 situation without delay.

A diagram showing factors that can become a true medical emergency when combined with low blood pressure.
A diagram showing factors that become a medical emergency when combined with low blood pressure.

Here is the list of the six most dangerous medical events associated with low blood pressure:

  1. Aortic dissection
  2. Blood clot in the lungs
  3. Major heart attack
  4. Sepsis
  5. Internal bleeding in the gastrointestinal tract
  6. Adrenal crisis

Low blood pressure with aortic dissection

Aortic dissection is a very dangerous medical condition and is a true medical emergency where every second counts. When you have low blood pressure with aortic dissection, you may not make it out alive unless your treatment is started right away. Aortic dissection is a tear in your aorta (the main artery coming out of your heart) that results in blood rushing down in-between the torn layers. When you have low blood pressure along with aortic dissection, it means that your aortic dissection is on the verge of bursting or has bursted already. It could also mean that the bulging from being torn has compressed your heart, diminishing blood flow. In any case, low blood pressure with aortic dissection can result in death without urgent surgical repair.

Here are the symptoms of low blood pressure along with an aortic dissection:

  1. Sudden onset sharp, tearing chest pain radiating to the back
  2. Feeling dizzy or lightheaded at the same time
  3. Sweating heavily while having the above two symptoms

If you have a combination of those symptoms, you have to think about low blood pressure with aortic dissection and need to call 911 right away.

Low blood pressure with a blood clot in the lungs

When you have low blood pressure with a blood clot in the lungs, it means that the clot has blocked the circulation of blood between your heart and your lungs. This type of blood clot can make your heart stop and result in cardiac arrest very quickly. It is important to recognize symptoms of blood clots in the lungs and low blood pressure.

Here are those symptoms:

  1. Sudden onset dizziness or lightheadedness associated with one of the following:
  2. Shortness of breath with an increased heart rate
  3. Sharp pain in the chest when breathing
  4. Sudden collapse
  5. Sudden cardiac arrest

A blood clot in the lungs with low blood pressure may have many different variations of the above symptoms, but all of them have one thing in common: the symptoms start abruptly out of nowhere and make you feel completely different. If that happens, call 911. A blood clot in the lungs with low blood pressure requires a quick treatment with clot-busting medications to save your life. In some cases, it maybe necessary to perform rapid surgery to take out the clot. Without a quick treatment, death is the most likely outcome.

Low blood pressure after a massive heart attack

A massive heart attack is a life-threatening medical emergency; a massive heart with low blood pressure can result in death very quickly without immediate treatment. If you have symptoms of low blood pressure with heart attack symptoms, it is truly the kind of medical emergency where every second counts. You have a very narrow window of opportunity to save your life. If you or your loved ones have these low blood pressure symptoms with a massive heart attack, you need to call 911 right away.

Here are those symptoms:

  • Feeling dizzy and lightheaded after one of the following:
    1. Heavy chest pain in the middle of the chest
    2. Left arm pain
    3. Jaw pain
    4. Sudden onset heavy sweating
    5. Tightness and pressure on your chest
    6. Left shoulder pain
  • Sudden collapse
  • Sudden cardiac arrest

Low blood pressure with sepsis

Sepsis is an overwhelming reaction to an infection. When your blood pressure goes down with sepsis, you go into a state of shock. Septic shock can kill you very quickly if treatment is not started right away. It is important to look out for low blood pressure symptoms whenever you are struggling with an infection. If you have symptoms of an infection, you need to look out for symptoms of sepsis and low blood pressure. If you truly have low blood pressure with sepsis, it is a medical emergency and you need to call 911 right away.

Here are those symptoms:

  • Fevers and chills along with one or more of the following:
    1. Dizziness and lightheadedness
    2. Feeling like you are fainting
    3. Heavy sweating
    4. Rapid heart rate
    5. Breathing fast and shallow
    6. Suddenly looking pale
    7. Cold hands and feet
    8. Extremely low energy
    9. Rapidly worsening confusion and disorientation
  • Fainting while suffering from an infection

Low blood pressure with internal bleeding in the gastrointestinal tract

The gastrointestinal (GI) tract includes your food pipe, stomach, and intestines. Internal bleeding in these organs can be very dangerous. When you have symptoms of low blood pressure along with symptoms of bleeding in the GI tract, it is a medical emergency.

Here are the symptoms of GI bleeding:

  1. Throwing up bright red blood
  2. Black tar-like stool
  3. Black diarrhea

Here are symptoms of low blood pressure from a GI bleeding:

  1. Dizziness and lightheadedness
  2. Fast heart rate
  3. Rapid breathing
  4. Feeling like you are fainting
  5. Passing out or falling down

If you have a combination of these symptoms, you need to call 911 without delay. You can check your blood pressure at home while waiting for the ambulance, but don’t delay calling for help while trying to find your blood pressure machine.

Low blood pressure with an adrenal crisis

If you have been diagnosed with adrenal insufficiency, you probably understand what an adrenal crisis feels like. An adrenal crisis may be the first sign of adrenal insufficiency if you did not know you had it. Please read this article if you would like to properly understand what an adrenal crisis is.(link)

If you have the following symptoms developing rapidly within a few hours and making you very sick, you need to think about low blood pressure with an adrenal crisis. Here are the symptoms:

  1. Nausea and vomiting
  2. Feeling extremely tired
  3. Lightheadedness when sitting up
  4. Very low energy; unable to get up without help
  5. Feeling very dehydrated with a dry mouth
  6. Headaches
  7. Confusion
  8. Disorientation
  9. Difficulty with speech

What to expect when hospitalized with low blood pressure caused by a medical emergency

If you have low blood pressure from a major heart attack or an aortic dissection, you may be quickly transported for an urgent procedure to make you stable. If you are found to have a blood clot in the lungs with low blood pressure, you will get clot-busting medications to try to dissolve the clot. If that can’t be done or if it doesn’t work, you may need urgent surgery to take the clot out. For an adrenal crisis and sepsis with low blood pressure, you will get IV fluids and medications to push your blood pressure up. With internal bleeding, you may need an urgent blood transfusion along with IV fluids first. Eventually, you will need diagnostic procedures to pinpoint and treat the site of the bleeding.

In all of the medical emergencies, you can expect the following after being hospitalized:

  1. Admission to the ICU with the close monitoring of blood pressures
  2. Multiple IV lines with fluids and medication drips running
  3. Potentially placed on a ventilator and other life support equipment
  4. A team of doctors monitoring your different organ systems

In conclusion, it is important to recognize certain life-threatening medical emergencies associated with low blood pressure. In most situations, every second counts. Do not delay calling 911 if you have low blood pressure with symptoms suggesting life-threatening medical emergencies.

References:

https://journals.lww.com/shockjournal/Fulltext/2004/11000/SEVERITY_OF_EMERGENCY_DEPARTMENT_HYPOTENSION.3.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520577/

https://www.nejm.org/doi/10.1056/NEJMra1208943?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov