That excellent communicator York cardiology has just done a video on blood pressure youtube.com/watch?v=q7V7Dss... . This included the simple definitions:
The Systolic blood pressure. This is when the heart is pumping and ejecting blood into the vascular system and therefore is the highest pressure that the circulation is exposed to
And the diastolic blood pressure.This is when the heart is relaxing and filling with blood and therefore the lowest pressure within our circulation.
As the usual concern is over clots starting by blood pooling in the heart when an AF episode has occurred, is it logical to conclude it is better to have higher blood pressure, especially the systolic level, so the clot has less chance to form due to ejection pressure ie those with higher BP are at less risk?
I am curious because my lowish BP has not been mentioned by my cardiologist when we discuss whether to start ACs or not.
Anybody out there with relevant medical knowledge or a more scientific brain than mine? Could of course be that this makes no sense at all as typing early morning!!
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secondtry
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Yeah, look I've viewed it. No, I don't have one of those brains you discuss.
So, my view is it seems as if you are talking about two non related issues. Surely, there is no relationship between a clot forming and blood pressure kicking it into touch somewhere. I mean surely, clotting relates to the viscosity of the blood. Nothing to do with blood pressure.
If ones blood pools AND the viscosity of the blood is such that its stickiness causes a clot to form that function initself is irrelevant to blood pressure. Which is why we take an anticoagulant. As BobD has pointed out correctly for aeons, its not blood thinners, the anticoagulant is to address and ensure that the viscosity of the blood is as close to normal viscosity as possible and that as such, the anticoagulant deprives the pooling blood of the opportunity to clog up and clot. i.e., it keeps the viscosity correct.
I know I'm not explaining this very well but using the word "viscosity" is the only term I can use to say what I mean. Like car engine oil where it is graded by viscosity, so, I understand the same applies to blood and at a certain point if the viscosity is such that the blood in its pool all clings together and clots then thats it. Blood pressure is in my view nothing to do with that.
Hi John - I know you have done a lot of research but just one point - I was under the impression that blood viscosity per se is not the issue - but the behaviour of the platelets which stick/clot together which changes the viscosity? Different anticoagulants change the behaviour of the platelets by inhibiting the clotting cascade at various points - the DOACS work at an earlier stage of the clotting cascade to Wafarin which is why they are preferred by some doctors over Wafarin.
As you know the problem comes from platelets when blood pools and then form clots whenever you do not have a smooth, even flow - which is exactly what happens in AF because - going back to the tap analogy - the tap is being turned on and off irregularly. So in my mind, BP/viscosity when discussing AF, are related.
I think everything in the human body is related to everything else but often in subtle, none mechanical ways which are more difficult to explain.
Viscosity is in fact "thickness" or the ability to flow. Anticoagulants do not affect this . What they do is reduce the ability to clot by removing some parts of clotting process . Anti platelets such as aspirin or clopidogrel work to reduce the stickyness of the platelets. It is for this reason that antiplatelets are recommended where mechanical valves or other non natural features are fitted or where restrictions in blood flow due to plaque may risk further blockages. They have little affect on stroke prevention in AF as we should all know by now.
Exactly what I said below. Platelets are suspended in serum - when they clump together they disrupt the ability to flow. Coagulation comes prior to clumping.
Hi John, I think you are probably right the main risk is the viscosity....... but my thinking is if blood pressure was mid range then that might be enough to stop all but high viscosity blood from pooling in the atria. As Threecats points out high blood pressure does not decrease the risk further but increases it due to vessel wall damage.
In summary low & high BP may not be good. However, this sort of guesswork is way past my salary scale!
Good question - things are a lot more complicated than just the pressure. Think of the hose and the tap analogy - the more you open the tap, the more water into the hose but if there is kink in the hose the pressure builds at that point. That’s why heart attack / stroke risk increases if you have high BP, but it also needs to be balanced against your risk of bleeds. That’s assessed by the cardiologists using various of algorithms, best known and most used known as CHADSVASC score.
If you have consistently low BP you are more likely for blood to pool in the legs and form clots but they come most often in the form of DVTs and from sitting or standing for long periods and blood stagnating in the lower limbs which why movement is so important for us.
Some people also have blood nicknamed ‘sticky blood’ (relates to the viscosity which John mentioned in his reply) which is caused by platelets behaving differently and stick together in which case people take antiplatelet medication as well as or instead of anticoagulants. But that is completely different to the type of clot that can form in the heart because of AF.
A high BP ie: over 130 - will increase your CHADSVASC score when the assessment comes to see whether or not to prescribe anticoagulants - that’s why your cardiologist mentioned it I suspect.
One final point - there are some indicators that the difference between your systolic and dystolic pressure could also be significant of problems if there is a very large difference. An ideal range of 90/60 to 120 /90 is considered ideal.
Personally, I found that with low BP it depends upon the person and how symptomatic you are - or not.
Thanks CDreamer & John, I need to re-read your replies again later to let it sink in. I haven't really got my head around the various factors at play. Much appreciated and have a good week.
Yeah, thats what I was trying to say CD ............. just didn't have the vocabulary for it .......... that's exactly what I meant .......... " have blood nicknamed ‘sticky blood’ (relates to the viscosity which John"
Just not up to speed on all the terms/terminology etc. etc. I wrote wot I did in the early hours due to my being awaken from a bloody pain ridden sleep.
Reading back over what you and BobD wrote reminds of the days in the late 1990's just before the turn of the millenium, when GP's in Australia where I was living at the time accepted a BP of 140 ish/80 ish as quite normal.
When I returned to Britain I did my PCV (bus drivers licence) driving test and got a bus driving job. The Medical team of the bus company gave me a medical and my BP clocked 155/70 or close to it and accepted that as appropriate for bus driving. I don't think that has changed even today. 😱😱😱
The BP ‘normal’ range seems to change every other week and US work from a much lower baseline. My husband has lived with high BP forever and thinks ‘no drama’ if he feels ok and it’s under 180 🤷♀️
Yes, I tend to rely more on my personal test history these days as well, both to determine what is 'normal' for me and to identify trends good or bad! As I am interested in all medical matters, I have kept a record of tests going back many years, not much effort and can be useful at times.
There is no connection between ejection pressure and clot formation. The reason we include high blood pressure when working out CHADSVASC score is that this is another risk factor due to the damage it can do to the heart.
Remember that the important thing is the differential between the two figures as this is what pushes the blood round the body. so a BP of 100/80 has less force than one of 100/60. . Conversely whilst a pressure of 140/100 may look to have the same force, the high diastolic pressure is unecessarily working the poor old heart.
Clots are generally believed to form in the left atrial appendage where blood pools but it must also be remembered that due to the changes in the internal surface of the heart that AF creates there can be areas of eddy elswhere that can allow clots to form.
Thanks BobD that's good to know. I checked my last 10 yrs readings and the differential averages 42, with average systolic at 112. So I will check this out with my cardiologist later this year.
An interesting thought Secondtry. I’m afraid I have neither a medical background nor a scientific brain but that won’t stop me😊
My own thought is that higher blood pressure would be more inclined to increase the risk of blood clot formation. My understanding for that thought is due to the endothelial tissue that, as you know, lines the inside of the heart and blood vessels. This lining is more likely to suffer damage when the force of blood pushing against it is high, as in the case of high blood pressure. If that damage causes the underlying tissue to be exposed then the body goes into repair mode and that’s when clots could possibly form, hence the lower the pressure, the better, in my view.
Yes thanks Threecats that sounds very plausible. I guess this could be strokes from the company AF keeps rather than AF itself. So BP as with most things is best in moderation.
I have little squirmy veins, the phlebotomists always tell me after they fail to get blood for a test. Does anybody know if that affects blood pressure/ heart disease or anything? I've never seen it mentioned.
After a blue thick dye was put through my left arm 1 hour before operation for thyroidectomy, veind dropped and the blood suckers cannot take blood out of my left arm.
spidery veins anywhere say on wrist is natures way of cooling down.
spidery veins in top of legs could mean varicose veins. Hope they dont get worse.
There was an excellent presentation ar the virtual patient's day about this from professor Tim Betts where he explained that the issue is the Left Atrial Appendage- a little appendix where the blood tends to pool. From there, if a clot forms and then doesn't resolve it will be pushed upwards to the brain. He was talking about a newish procedure called LAAO where they plug the appendage, so the blood cannot collect there. Currently we can't elect to have this procedure as its only available for those medically unsuitable for anticoagulants.
Recommended. I think you can still join, or check out LAAO procedure on YouTube.
My cardiologist put it to me this way. You have Afib and even though you are now in NSR because of medication and an ablation there is a good chance that you will go into Afib again sometime in the future. Since we don't know when exactly do you want to chance an Afib episode resulting in a clot and stroke? That's why you take the thinner. Currently on Apaxiban.
I totally respect the input of your cardiologist and am sure most will say the same. However, I think us AFers are part of the medical team and we shouldn't accept any decision (not just ACs) on a unilateral basis ie 'my doctor said so'.
At age 60 my cardiologist also recommended the same as yours. I considered it carefully and decided to postpone ACs for the following summarised reasons: I has Lone PAF and am symptomatic, I had pulsatile tinnitus (daytime monitoring), I was prepared to make numerous lifestyle changes, I had an active life, I was anti-pills and concerned over bleeds (stomach weakness & other issues), effectiveness of ACs only around 65% with limited track record at the time of side effects, recommendations of the European Cardiology Assoc less stringent and lastly I understood from random checks of the Public there are probably millions of people unaware of their AF and only a small percentage of those are dropping dead.
My cardiologist respected my decision and with a CHADS score of 1. I agreed there was still a risk but it was reduced. He agreed there was room for postponement of ACs. So I am currently 69 yo and review my circumstances annually with a private check up with the same cardiologist. I fully expect to take ACs before I reach 75.
IMPORTANT NOTE: So I don't get censored by Admin for this reply...... I stress I am NOT advocating stopping taking anti-coags which are important for most here, just don't take them without full consideration of your own individual circumstances.
It’s totally a personal decision and you have taken an informed decision and I made a similar choice at the same age, with similar circumstances.
I also prefer to be involved in the decision making process, not everyone does though and that is their choice. I think after the Shipman tragedy many of us became somewhat more savvy and questioning.
Hi just read your reply I am 67 diagnosed with AFib 2021 .I took myself off edoxaban last may after not being aware of any episodes until Nov 22 when it kicked in again I went back on edoxaban straight away that episode lasted 5 weeks I am now on flecainide which put me back into sinus within 2 days I continued the edoxaban until I picked up this bad respiratory virus that's going around and developed a nose bleed I immediately came off my edoxaban and started monitoring almost 24/7 I have a wearable Wellue monitor you can use whilst sleeping. I mentioned this to my consultant he was comfortable with my actions providing I go back on anticoagulants should AFib return. There have been a number of studies where people with a low chadsvasc score have been using anticoagulants as a sort of pill in the pocket only taking them when they go into AFib and for a period after this is becoming more feasible now with personal monitoring devices you need to be strict though. Ps my score is 2 hope this is of interest.
I had an Embollic Stroke affecting left frontal brain in Sept 2019. I was not on any drugs.
It happened at 2am when my H/R goes down to 47 avge H/B per minute.
I was showing a 150s Systollic BP. We had tried Lovas..... but I was losing protein in my urine.
Factors I was stressing about our NZ ACCs decline of removing Johnson & Johnson ugly horrific mesh kit. It was 2mm from causing damage to a major feminine organ. InNov 2021 specialist confirmed damage as did a 3D scan.
Removed March this year.
While in hospital found to have AF. 4 days later a Carotid Arteries scan showed Thyroid Cancer. Removed with 12 right lymph nodes Feb 2020.
I was put on PRADAXA 110mg. Changed with the transfer to a closer hospital 150mg again twice a day.
2 years 3 months found out the change, was livered and changed back to 110mg twice a day. 1 I was 70 then in 2019, now 72 and I had a heart condition.
PRADAXA has a ? as some research has noticed 33% rate of Heart Attacks.
My Af was diagnosedas Rapid and persistent. Night rate has always remined the same and on Metroprolol showed 2 x 2 seconds pauses at night. Bisoprolol didnt as Diltiazem also.
I was taking the new CCB introduced by private H/Specialist with 2.5 mg pm Bisoprolol. 123/72. 77-88 H/R Day. 47 Night
Yesterday Dr took me off Bisoprolol as BP 115/70. 70 H/B. Still on PRADAXA. She did ? 110 and twice a day.
Good we will see how that goes. But it is on the cards that my heart may revert to regular electrical sinus. I've crossed my fingers for a long time.
It will be great not to have to take an anti-coagulant!
So my stroke happened at low aF and H/R. I see what you ae getting at, though.
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