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BP lower in one arm by 15 or more points - Harvard/Lancet paper

Posted , 4 users are following.

LizUK
LizUK

Anyone experience BP lower in one arm by 15 or more points? Cure? If left unmedicated, does this harm the heart? I believe Harvard Medical School had a paper in The Lancet on this differential. Anyone here seen the whole thing?

When my lunchtime Left arm BP is 140/70, after required 5-minute pause, my Right arm is 125/55. This is when my AFib is unmedicated. For 6 weeks I took Verapamil 40mg calcium channel blocker (I'm asthmatic, so beta blocker is contra-indicated). I ceased after 6wk because my late-evening BP readings had a 33-point differential (Left arm 113/70, Right arm 80/46) and I experienced generalised oedema, worsening daily. 6 wks without any AFib medication, my equivalent late-evening BP averages Left arm 110/45, Right arm 95/53.

AFib started at age 36 years when I was dropped onto my *front* while under general anaesthetic at a teaching hospital, for routine lower-back surgery (stiff breathing tube in my mouth), resulting in 'slipped' disc (C5/C6), dislocated jaw (Right TMJ) and dislocated Right shoulder. AFib undiagnosed until 21 years later when rapid pulse (134) detected by GP.

My cardiologist dismisses BP differential between arms, preferring to put me on Beta Blockers, despite my being asthmatic, and the asthma being ineffectively treated - Peak Flow of 290 upon waking, but should be 410 minimum (for gender, age, height). For many years, I've taken Ventolin every 12 hours (to open airways) + half-hour later Symbicort 400 steroid (Budesonide).

Please give tips on how to gently persuade NHS to finally help me deal properly with the constant dizziness and swift breathlessness upon exertion, that I've experienced for 21 years. My life has been on-hold. Family pressures mean I *must* become more able. Frankly, in my sole visit to the cardiologist I found him callous. He doesn't plan to see me again for 6 months. Should I consult a Neurologist to ascertain whether Vagus Nerve injury could be causing my AFib? Ideas, please?

0 likes, 6 replies

6 Replies

  • BampaOwl
    BampaOwl LizUK

    Posted

    I'm not sure how much help I can be, apart from observing that if I take my BP five minutes apart in the same arm it can be 25 units adrift. A lot of the time my BP is very variable, even when not in AF (which is most of the time). TBH I don't think I, or a health professional, have ever checked my BP in my right arm!

    The other thing is, how about seeing a cardiologist privately? I was pleasantly surprised that a single visit was not exorbitantly pricey, and I got nearly an hour's attention instead of 15 minutes.

    PS: I see now that my (Boots) BP monitor does mandate a five-minute pause between readings. I have never seen health professionals follow this practice, and neither do I. Other things being equal (!), I find that successive readings are consistent.

    • LizUK
      LizUK BampaOwl

      Posted

      Thanks, BampaOwl - were you able to arrange direct to consult a cardiologist privately, or did you have to involve your GP? What sort of cost?

      Corrections to my post:

      80m Verapamil taken by me for the final half of my 6-week course.

      Unmedicated Left arm blood pressure average 110/68, Right arm 95/53. Meanwhile pulse varies wildly in range 88-110 after 2 hours as couch potato before bedhime, but is 140+ after 10-minute walk and I feel close to blacking out.

      I made mistakes 'cos tearful from frustration and disappointment, after waiting 3 months to see a cardiologist, only to find him callous, and his staff had wiped my 24-hour heart rate monitor (Holter tape) without downloading the data, and the replacement's batteries died soon after I started using it!

      Wonder if anyone else will be kind enough to share experiences?

  • Okapis
    Okapis LizUK

    Posted

    What does your GP say? You could always ask for a second opinion at a different hospital. Or as suggested you could go private for one session and then transfer back into the NHS.

    So you've not had the results of the Holter monitor test? You should at least have that redone. If you've had the AFIB for so many years has anyone suggested a catheter Ablation?

    If you are becoming increasingly breathless (and its not due to the asthma) then it sounds as if it might be time?

    • LizUK
      LizUK Okapis

      Posted

      Thanks, Okapis. More than 3 weeks until any appt's available to see GP. Hospital haven't yet offered re-try with 24-hr Holter tape recording, after they accidentally wiped the 1st & used depleted batteries for the 2nd. I'm extremely keen to test my limits at daily activities + something closer to my old habits - gardening and cycling. Or at least pleasure walks, not merely unvoidable walks with food shopping.

      Although I've been AFib constantly for 21 years, it was only diagnosed 3 months ago. GP then felt Cardioversion likely solution, but Cardiologist didn't even suggest it. Merely proposes to put me on Bisoprolol. Dismissive of beta blockers being contra-indicated due to my asthma.

      I see asthma medicine Ventolin can cause heart flutter, which is what I have had for these 21 years. I hope NHS personnel properly communicate.

      >> Anyone here know if there is an alternative to Ventolin?

      I'm wondering if I would no-longer be AFib, if I could cease taking Ventolin. A month ago, I halved my Ventolin from 2 puffs every 12 hours - to open up airways for Symbicort 400 turbohaler. No loss of Peak Flow. Unfortunately it's unsuccessfully treated, but today I've looked online at NHS website. Discovered only supposed to wait max 15 mins between Ventolin and Symbicort, whereas Asthma Nurse + Respiratory Consultant (when last seen, over 2 years ago), said wait half an hour between the meds. Today I learn Ventolin effect lasts only 15 minutes. Just shows importance of researching online, regularly!

      Thanks, also, to BampaOwl who I see tried to post a reply 4 hours ago, but it awaits m o d e r a t i o n...?

    • BampaOwl
      BampaOwl LizUK

      Posted

      It's because I included a link to an external site. Hopefully should appear over weekend.

  • BampaOwl
    BampaOwl LizUK

    Posted

    Liz - As far as I remember I did discuss seeing a cardio privately with my GP, and he was happy with it. I phoned our local private hospital (BMI group) to make the booking - very quick! The consultant I saw also works at our local NHS hospital. It cost about £100. (I have also, rather irregularly, been seeing a consultant at teh same hospital for rheumatoid arthritis. He's a bit cheaper!) NB I live in Scotland.

    There's useful information about monitoring BP at http://www.bloodpressureuk.org/BloodPressureandyou/Homemonitoring/Howtomeasure - it does say that BP can vary slightly between arms, and recommends two minutes between readings (in the US it's apparently one minute!).

    I suffered from breathlessness on exercise from going onto daily beta blockers (mainly Sotalol) for a year or so. But for the last few months I have been a good bit better in this respect. Perhaps I am getting used to the BBs. And my AF bouts seem to be less frequent.

    But be aware that it seems that almost every case of AF is different! Even without complications like Asthma.

    Best of luck!

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