Low blood pressure with AF episode

[Blimeyohriley]

Does anyone get low blood pressure with AF? I was diagnosed a few years ago with paroxysmal AF. The last 2 episodes I’ve felt quite faint / lightheaded. I took my blood pressure just after my latest 30 hour episode this morning - was shocked to see it was 80/56. My blood pressure is usually on the low side as is my resting pulse but I feel fine. My pulse this episode was around 70bpm. I’m on 1.25 Bisoprolol (higher dose drops my pulse too low) and Apixaban. The low blood pressure scared me. Does it indicate heart failure? I’m assuming I should’ve taken myself to A&E rather than wait this out as I usually do? My last echocardiogram in May was fine, with slight narrowing of the aortic valve.

[Jalia]

Are you dehydrated? When my BP has fallen too low in hospital I've been given extra water to drink which has often resolved the low reading. Keep well hydrated at all times, particularly when in AF. Obviously it would not be good to have such a low reading as this continuously so do seek docs advice if it persists.

[jeanjeannie50 in reply to Jalia]

I was just going to say exactly the same as Jalia . I too was told in hospital to drink more water to bring my BP up.

[Blimeyohriley in reply to jeanjeannie50]

Thank you both for responding. I don’t think I was dehydrated. I’m quite good at knocking back the water. I’ve had the same experience in hospital- always told to keep hydrated.

[Snowgirl65 in reply to Jalia]

I honestly didn't know that drinking water will help when in a-fib. Wish I knew that sooner -- thanks for your response to Harbie.

[CDreamer]

I always had very low BP even before AF but with AF I did faint as BP went unreadable. Nothing could be done except stay with your feet up, hydrate very well & keep Electrolytes well topped up.

If you went to A&E all they did for me was a saline drip & discharged. Avoid standing - blood pools into legs & don’t try to be active whilst in AF - just makes everything worse.

Oh & take salt - 6g+ daily.

[Blimeyohriley in reply to CDreamer]

Hi CDreamer, That’s reassuring. I did wonder about electrolytes. I don’t feel so anxious about the next time now and will take your advice. Thank you.

[Hidden]

G'day Harbie,

When I was first diagnosed with paroxysmal AF back in the day, January 2010 (age 65) my average BP was around the 136/80 with a heart rate of 88 plus. The day AF mugged me my BP dropped to 76/50 and HR rose to 156. GP sent me to A & E and the AF diagnosis followed.

I opted for treatment on the medication route, I rejected any notion of ablation, and during the first 12 months I added lifestyle and dietry changes to my methodology of dealing with AF. That is still the case. BP these day (77 next month) is in the range 109/61 to 143/81 with an average of 131/70. My HR these days bobs about but is pretty steady in the range of 64 to 67 bpm. Sometimes drops as low as 46 or 49 and I feel crap. My BP has never dropped that low (76/50) ever since I've been on BP and AF medication.

John

[Blimeyohriley in reply to Hidden]

Hi John, good to hear you’ve got it under control. I’m about to embark on the ablation route at Oxford JR. I wonder how long the wait is with covid n all though…..

[Visigoth in reply to Blimeyohriley]

Please let us know how you get on at Oxford JR. That’s where I’m going to have mine if I decide to go for it. Dr Rajappan indicated the waiting lists weren’t too bad.

[Blimeyohriley in reply to Visigoth]

Hi Visigoth,That’s reassuring. The last (and first) time I saw my cardiologist was about a year ago when he suggested an ablation but the risks he then shared terrified me so I said no thanks. He said to go back to him at any point if I changed my mind. So, here I am with my mind firmly changed after numerous and increasingly lengthy afib episodes and feeling rougher with each one. I’ll let you know how it all goes.

[Visigoth in reply to Blimeyohriley]

Thank you, yes please do. When I was first diagnosed with a fib I was all gung ho about an ablation, having had an EP study done about 10 years before - I assumed it would be similar! Then I found out about all the risks and the blanking period and I was a lot less keen! I think I’ll go for it eventually but I’m trying to lose some weight first as the cardio said it would help. Not that I’m hugely overweight but I need to get my bmi down to 25 or under.

[Blimeyohriley in reply to Visigoth]

I’m the same regarding weight. Was only (?) about 2 stone overweight - lost 1.5 stone recently after reading the book ‘The Afib Cure’. The last time I had another echocardiogram the guy asked if I’d put on weight as he was having to press quite hard to get a decent image. I had put on weight - so that too encouraged me to lose weight and change my lifestyle. The changes reduced the frequency of my episodes but just a little. Feel better for it otherwise though. Fingers crossed an ablation will do the trick for us 🤞(if you choose that route).

[Visigoth in reply to Blimeyohriley]

Wow, well done on losing weight after reading the AFib Cure. I’ve read it but I struggle to be as rigorous as I should be. I changed to a mostly plant-based diet but I still have some things that are processed, eg bread. And the odd treat! I’ve lost about 4 pounds but that’s it.

[Blimeyohriley in reply to Visigoth]

It’s not easy is it. I think for me, the biggest change was much smaller portions and cutting back on snacks & carbs. I was already on a mostly plant based diet. I can’t shift the last 1/2 stone, I seem to have plateaued. I’m with you, I still have the odd treat, can’t deny ourselves everything. Otherwise what’s that old saying? You won’t live any longer but it’ll feel like it. Lol.

[TheProf]

I'm on flecainide and i have odd palpitations. Usually at 75-80 bpm. I took my BP during one of these and it was anout 20 points lower than usual. My uual resting pulse is 40-50 with BP 125-130/70.

[Blimeyohriley in reply to TheProf]

I completely forgot to add I took a pip - flecanide. I wonder if it contributed.

[Tennisking in reply to Blimeyohriley]

Yes mine always drops during an episode. Be careful with large pip dose of Flecainide - I had to stop using this method as it caused 6 second pauses between heart beat re: blacking out symptoms.

[Blimeyohriley in reply to Tennisking]

Cripes. Thankfully I see my cardiologist on Monday (starting the previously rejected ablation offer) so I’ll chat to him about it.

[Singwell]

Harbie I've had low BP after AF too. Mine was 65/40 with a pulse of 43 and I've never felt so awful in my life. It was off to A and E!! I was able to discuss this with my EP and we decided it was a loss of electrolytes due to the peeing one does during an episode and then water replacement if you keep hydrated. You say you did that. So overall your electrolytes would've been depleted. That night when I had my low BP I asked my husband to make me a miso soup whilst waiting for the ambulance. My BP slowly crept up and by the time I got to A and E my electrolytes were in normal range. So my advice is to keep some organic coconut water to hand and a packet of miso soup. (My EP told me to buy some electrolytes from the chemist and I do have them but they're completely disgusting.) Hope this helps!

[Blimeyohriley in reply to Singwell]

Hi Singwell, I recently bought some organic coconut water after reading posts on here. Time to open it methinks. I’ll get some more back up products too.

[Singwell in reply to Blimeyohriley]

Yes, it's all about management. And because we aren't advised on these things we often end up in A and E unnecessarily. It was folk on this forum who told me about the body jettisoning sodium during an AF event - hence peeing - I then told the medics at the hospital! Another thought - lots of people here say to hardly eat or eat light during an episode so as not to exacerbate the disturbed system. That night I'd only had soup - mistake! I've since found that if I do have an AF episode, if I take my pills, wait 40 mins then eat something with carbs, it'll go away. Not saying this will work for you but it does for me and others have said the same. Something to do with rest and digest - initially food raises the metabolic rate when you start eating - then it lowers during the digestive process. Hence 'rest and digest'. I've learned so much here!

[Blimeyohriley in reply to Singwell]

That’s useful. Thank you. I'll bear that in mind. I’ve significantly changed my diet over the past few months. Smaller meals, much fewer carbs. Oh yes. I’ve learnt sooo much from this forum. I was terrified and looking back quite left in the dark when first diagnosed (not that it doesn’t raise my anxiety now!). Information is king in my book.

[Singwell in reply to Blimeyohriley]

Same!

[Golfer60UK]

Hi Harbie, I have had two ablations and now a pacemaker initially set at 80 - 120 beats per min. After my first review it is possible they will be altered. My BP is generally on the low side and HR 80 - 95.I was on bisoprolol 1.25mg and apixaban, now only on apixaban. The reason for the pacemaker was due to me passing out on the golf course with the consultant suggesting this to stop further episodes and for better control.

However I have since passed out again so now on further tests to determine why. At the time I was hydrated so that's out.

Best of luck

Dave

[Blimeyohriley in reply to Golfer60UK]

Hi Golfer, it’s hard work all this fine tuning!

[Golfer60UK in reply to Blimeyohriley]

You're not kidding, I've lost almost a year's golf !!!!!! and at 76 can't really afford the time, lol

Dvae

[Trigeminyblue]

I think that when having a PAF episode, because the upper chambers of the heart are not contracting strongly & regularly then not enough blood is being pushed through into the Ventricles & then into the general circulation and so your normal BP is unable to be maintained & is likely to be much lower than what is normal for you. My own BP is usually about 135/ 85 & falls to between about 90 to 105 over about 60 during a PAF episode. Usually makes me a bit faint or wobbly so I take more care and ensure I drink more water. If you are one of the people who also have to pass a lot more urine during PAF then that will also lower your BP. During an episode of PAF. Your pulse will not reflect your actual heart rate as some of the beats are too weak to be palpable, radial pulse (felt in the wrist) may register possibly 80 bmp but in actual fact may be more like 160 bmp or even more heard with a stethoscope over heart. BP is usually unreliable too as most BP machines are unable to pick up the pressures correctly & just give what is an acceptable approximation of what is being measured. In short regard any measurements taken during an episode with suspicion. Go with how you are feeling & take care as suggested in previous replies. Chris

[Blimeyohriley in reply to Trigeminyblue]

Thank you. I spoke to my doc late yesterday and she mentioned your points exactly.

[momist in reply to Trigeminyblue]

Very good post. I agree entirely. Thanks.

[Singwell]

BTW interested in your profile comments on flight fight and freeze. Since developing AF I've had to come to terms with huge amounts of anxiety - I'd no idea I was 'hypervigilant' - I thought anxiety was normal. Lifelong learning.

[Blimeyohriley]

It’s fascinating how it affects the body. Since diagnosis of cptsd and specialist trauma treatment I’ve learnt so much.

[Tomred]

Yes I've been getting this around a year now makes me feel particularly miserable also on 1.25 bisop I've been trying a good pitch of salt in my water I normally take pink salt which apparently is devoid of sodium

[Blimeyohriley in reply to Tomred]

It’s no fun is it. I hope you find your resolution.

[JefferyW]

I had my Ablation at the JR and was really apprehensive about it. 6 weeks on and I am really pleased with my progress and feel in the best of health for three years. I would thoroughly recommend it and the waiting list was about 3-4 months when I plucked up the courage and went on the list. Regarding your blood pressure I would strongly recommend you speak to the specialist arrhythmia nurses in the cardiac unit for advice. Fantastic service and so caring. I can’t fault the support and care I have received.

[Blimeyohriley in reply to JefferyW]

Can’t deny I’m apprehensive. My cardiologist will put me forward to JR (my hospital is Milton Keynes) so guess it just depends on the culmination of waiting times. Your progress is reassuring. Thank you.

[biroman]

I started PAF seven years ago, when the AF only was only a day or two every six months. My BP ( on a wrist monitor ) drops steadily from 135/85 to 90/60 during the first six hours.

By 12 hours it is sometimes on the mend slowly rising again, but last couple of years the AF often continues for about 36 hours. Now it can be for about 10 days spread over a six week period, then nothing for a few more months.

(My normal daily dose of Bisop is now up to 3.75mg and also on Rivaroxaban. Can't go much higher as my resting pulse is around 58 and sometimes drops lower, which as others have said, feels awful.)

Having read the useful info here, I realise I should rest more during the AF, and eat less. Instead I generally continue walking slowly out to the garden with my dog, have also gone for a short dog-walk using a walking stick, and have eaten more or less normally whilst in AF, -maybe why mine continues for 36 hours. (If I didn't have the dog I would sit still.)

I assumed BP dropped for everyone in AF, but not so. One Cardiologist said if my BP drops to less than 90 (ie systolic, the first number) I should consider going to A&E, but now that I know the pattern of my AF it's only ever less than 90 for an hour or so before it gradually starts to come back up, so I just take an extra daily dose of Bisop when AF starts, and prepare to wait it out. I also now know to take re-hydration salts to compensate for the excess-peeing phenomenon.

(I declined an ablation, however I did pay attention to diet so since AF started, drink no coffee nor alcohol, just decaf tea -which is decaf to 0.02%. Also take a dialy magnesium glyconate supplement - don't know if it helps my heart but makes me dream a lot more! )

[Ppiman]

Don't we all worry and heart failure? Phew, I wish it were otherwise but the thought haunts me at times. But low BP during an episode is, I gather, normal and, in fact, very hard to determine using a home sphygmomanometer. My elderly friend is in permanent AF and the only symptoms it causes him are occasional fainting feelings, with three times where he has actually collapsed because of it over the years.

Steve