<s>[INST] 60 yr old woman, dying of pancreatic cancer.  Given 1/2 normal dose anabolic steroid to help reduce abdominal and leg/foot edema. Within 12 hours, heart rate up, difficulty breathing, BP low, and was told that IF the distance between systolic and diastolic gets less than 20 points, she needs to call for help.  Can you explain WHY that is a risk, what it means?  Also, wouldnt you expect BP to be higher with a steroid??  thank you [/INST] Thanks for your question on Chat Doctor. I can understand your concern. Yes, you are right about rise in blood pressure after steroid injection. But it is not true for all patients. The woman in question might be having heart failure. Heart failure can cause breathlessness, low systolic pressure (hypotension) and edema feet. In this, steroids won't help. Diuretic and other cardiac supportive Chat Doctor.  In heart failure, systolic pressure decreases fast then diastolic pressure. This is due to poor force of contraction by failing heart. So difference between systolic and diastolic pressures come down to less than 20. And when this occurs, patient needs urgent treatment in the form of isotropic  </s>