blood clots

[Musetta]

Hi Everyone,

A question I'd like to put out there is this - If a pulse is regular, blood clots do not develop in the heart - with an irregular pulse there is a possibility of clots forming. Is this correct? Any feedback on this?

[Japaholic]

My understanding is that clots develop when you are in AF, they can stay in the heart even when you aren't in AF, so the stroke risk remains. My EP said after ablation, even if I am AF free, I should stay on anticoagulants for 3 years. If I am still AF free at 3 years he would consider me cured and stop the anti coagulants. Regards the other drugs, he said he'd start reducing those after 3 months of being AF free.

[Musetta in reply to Japaholic]

Thanks Japaholic.

[Beancounter Volunteer]

Hi Musetta

First the usual proviso, I am not medically qualified, and all my knowledge and opinion is based on what I read (and the tremendous feedback on this forum)

I think your questions are great, because they cut through to the very core of understanding about AF and it's consequences, however I am going to caution you that not everything is black and white, nor has a yes/no answer.

For example, elsewhere you have summarised that regular pulse no AF, irregular pulse in AF. And the answer is Yes, most of the time, you need to understand that the pulse rate is ventricular, lower part of the heart, whilst AF is atrial upper part of the heart. It's certainly possible that you could have a completely regular pulse rate (Ventricle) whilst the left atria is fibrillating. It could either be that the fibrillation is not enough to effect the ventricular rate, or that the fibrillation is regular enough to keep the pulse steady.

Now that would of course be unusual and not the majority, but the one thing we certainly know about this condition, is that each of us is different.

So then come back to stroke, as japaholic says the risks continue long after the fibrillation, BUT even within a regular pulse can you be certain you are not fibrillating? Only an ECG can determine that I suspect so my answer would be.

If you have never had AF and your pulse rate is regular, then you are a normal risk of stroke for your age and other factors (not zero, clots can still form even without AF)

If you have had or are having AF, then even with a regular pulse, unless you have been in NSR for a relatively long time, and have had ECGs confirming no underlying fibrillation, then you are at 5 times the usual risk of stroke.

Hope this helps

Ian

[Holly10 in reply to Beancounter]

Does this also apply to ectopic beats? I had two episodes of AF three years ago and haven't had anything since but I do suffer from ectopic beats, sometimes so bad I can't distinguish the heart beat from the ectopic beat and feel feint. My GP doesn't take this seriously but surely it's just another arythmia that is potentially as serious as AF. Should I also be on an anti-coag.

Feeling very worried.

Holly

[Beancounter Volunteer in reply to Holly10]

Hi Holly

Truthful answer I don't know, so why not ring the AFA helpline, they should be able to tell you.

Be well

Ian

[Hidden in reply to Holly10]

That sounds like my situation Holly. I have extra beats in clusters all the time unless I take my drugs, which I do. My GP always thought my pulse was fine, the hospital staff didn't and either did my EP. I am on anti-coagulants for life. But I have a history of AF so not sure whether this because of the arrhythmia I have now, or my history of AF is the reasoning. Probably both?

Whatever, if you're getting a lot of ectopics like me, so that they feel uncomfortable and it's hard to find a pulse sometimes, I'd ask for a referral to an EP if you haven't already. Forget the GP.

Just my thoughts, no medical training whatsoever (except with sheep!).

Koll

[Holly10 in reply to Hidden]

Thank you Koll, I think I will take your advice. Holly

[Musetta in reply to Beancounter]

Once again Ian thanks for your informative reply. It has helped me understand it a little better.

[Bridges4 in reply to Beancounter]

Dear Ian

I am always so impressed with your knowledge and the help and advice you give to many people. You may not be medically qualified but, tell you what, I would be happy to consult you any time.

Power to your elbow!

Les

[BobD Volunteer]

The above two answers are quite logical and correct within reason but as Ian points out we are all different. Lets look at why clots form. Basically if blood is allowed to pool there is a risk of clots forming. Now because the left atria is not contracting in a regular way it may allow clots to form and many doctors believe that these will be formed in the left atrial appendage which is a small extra sack attached to the Left Atrium. It is for this reason that surgical removal of the left atrial appendage or occlusion of it by such as a watchman device is considered to drastically reduce stroke risk for patients with AF. Remember that we all have a risk of stroke regardless of AF or not, but we AFers have five times the normal risk plus whatever our Chadsvasc rating gives us.

Now for the tricky bit. AF causes changes within the left atria and even ablation causes scarring (that is what it is aimed to do) but this scarring can actually result in blood flow being compromised in the way that for example deposits in a water pipe can cause changes in flow. It is for this reason that many EPs consider that if you have or have had AF you should be on anticoagulation for life. End of as they say.

So in conclusion your idea whilst logical is not valid in the real world and I for one would not like to rely on it.

Bob

[Musetta in reply to BobD]

Thanks for your reply BobD - there's a quite a bit of info to digest!

[MarkS]

Just to add to what has been said above, AF is an inflammatory condition. Some specialists believe clots are more likely to form due to the underlying substrate (i.e. the inside of the heart) is inflammed, so if you have ever had AF, even for a few minutes, your risk is increased. So there is no definitive answer I'm afraid.

Mark

[fuzzflyer]

I have AF, on warfarin, had to have a hernia opp and told to stop warfarin 5 days previous to opp, blood clots formed 1 week later , stroke.

I think they should have given me a course of injections while off warfarin??. But probably financial restraints!!

[farmerwalt in reply to fuzzflyer]

Would agree with you fuzzflyer. I was in hospital recently for a Gallbladder op, that didn't happen due to my heart problems, and my warfarin was stopped about a week before the day the op was scheduled to take place. During that time I was getting daily injections of Tinzaparin to minimise the risk of clots. After I was discharged I was given Tinzaparin home with me and had to inject daily until my INR was above 2.0. I self monitor/manage my INR/warfarin so the hospital Dr was quite happy to allow me home as long as I checked my INR each day till it stabilised again.

Walter.

[fuzzflyer in reply to farmerwalt]

Yes. I was not given that drug until after the stroke! And at Portsmouth emergency not the hospital that did the operation" Hereford". They can ruin your life pretty easy it seems!

The Doctor was surprised I was not on tinsaparin!!

After the USA. The NHS seems third world

[Dadog in reply to fuzzflyer]

Good grief! If Cardios aren't aware of the possible effects of stopping anti coags - what hope for the rest of us?! Hope you are OK fuzzflyer.

[Tobw in reply to Dadog]

Agree totally. I was put on Clexane when I had to have a biopsy in the autumn and, to be honest, it got a bit of a bind as I had to go on injecting myself every day for nearly a month after the procedure and keep on attending the clinic every three days as my INR stubbornly resisted getting between the 2-3 mark, but I'd have willingly kept on using it indefinitely rather than leave things to "pot luck" like fuzzflyer appears to have been.

[Bev999]

I had planned major surgery nearly two years ago and same as Walter my Warfarin was stopped a few days before and I started Tinzaparin injections which continued until about a week post-op when back on Warfarin. I find it hard to believe cost came into that decision - sounds to me more like pure negligence!

So sorry to hear your story.

Bev

[Offcut]

You can develop blood clots in any part of your body. It could be a mild amount of damage or a bacterial attack within the blood vessels which can over time build up with the white and red cells do their job to protect your blood. Sometimes they will float about without any problems and be absorbed away. However if the route it took is smaller than the clot this can turn to a stroke or DVT. TIA are best described as tea leafs getting caught up in a pipe that can all of a sudden clear as the pressure moves it on though the brain giving you stroke like symptoms.

As has been said if the heart is irregular it can cause a vortex affect and have an area which is not moving enough for the body to make it clot to wrongly protect us. I had a heart attack because I lacked O2 to the heart muscle that was beating in excess of 178 BPM but not pumping much?

Be Well