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LAP is 15 and BP is fluctuating, had a second ablation for afib - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Average Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2570 Questions
User :   Had a second ablation for afib (touch up) it was successful so far, but only been about 20 days. BP and heart rate have been up and down. I noticed on my post op report that might left atrial pressure was a mean of 15. Is this good or bad and why is BP up and down. I wasnt on alot of BP meds before surgery and now I am or have increased them.
Doctor :   Hi
Doctor :   Let me read the query
Doctor :   Can you tell me the numbers of BP
User :   today??
Doctor :   Yes, you may tell for any day?
User :   They have been running around 152/98 to 115/72 up and down. When I take meds the bp goes down for a couple of hours and then go back up. Feel this in my eyes and slight headaches.
User :   What about that left artrial mean presssure of 15??
Doctor :   Yes it is slightly high
User :   Take Metoprolol 75 x2 and lisinapril 20mg x 2
Doctor :   The normal LAtrialpressure varies from 6 to 12mmhg
User :   HTN causing the high LAP
Doctor :   Pulmonary Hypertension can cause high LAP
Doctor :   Systemic Hypertension does not cause LAP unless there is back ward flow of blood, I mean organic problem
Doctor :   Do you have the ECHO report with you?
User :   O...I asked him about that and he said I didnt have pulmonary HTN
Doctor :   It is really important to understand the whole diagnosis and the management yet taken to give any thing specific about the pattern of illness
User :   I have echo report from NOV but I have post op report to from 2 weeks ago
Doctor :   Can you share that with me?
User :   which one??
Doctor :   Both of them
User :   On the post op report it states Intracardiac Echo was used to guide the transeptal puncture uneventually. Left artial pressure was a mean of 15. Left artrial angiogram demonstrated no abnormalities
Doctor :   Ok
Doctor :   Any comment about the valves
Doctor :   Or dysfunction ?
Doctor :   Systolic or diastolic dysfunction
User :   Not on the Post Op ablation report
Doctor :   Nov report
User :   On the ECHo in Nov of 2010 LV size is normal EF was 65-69%
User :   RV size normal, LA size normal, RA size AAAAAAA AO root mildy enlarged, AV No structral abd
User :   MV No structal MV noted
User :   PV No structal PV noted
Doctor :   Ok great
Doctor :   What is your age?
User :   35
Doctor :   What is the heart rate now?
Doctor :   Any comments made by the doctor?
User :   stand by
Doctor :   Is it fluctuating too?
User :   133/88 and HR is 87 when the medication wheres off it all goes up. Well BP does mainly in the 140-150 and dia is anywhere 85-108
User :   Heart rate after morning meds, by afternoon its around 95-102
User :   Goes down at night after I take meds til I wake up and BP usually is 142/85 and HR is 98-100
Doctor :   Ok
Doctor :   The BP is fluctuating largely in a day
Doctor :   We have to find a reason for it
Doctor :   Could be non worrisome too
Doctor :   but it warrants a complete monitoring
Doctor :   The medicines are alright, may be a correction in the timings or dosages should do the trick
User :   I do smoke and Im trying to stop. Im 6'1 and 250. Been walking 2 miles now for about 2 weeks and have drop some wieght. Thought BP would be better and it is at times but not like it should be with all that meds on board.
User :   Does this indicate early CHF? Or Pulmonary HTN
Doctor :   That is good to know that you are trying to quit
Doctor :   and you walk a good
Doctor :   It does not
Doctor :   Pul HTN has no reason after reading the ECHO
Doctor :   Yes I am here
Doctor :   To answer to your question
User :   Sorry..that was fast
Doctor :   Do you have swelling of feet or shortness of breath?
User :   No swelling, sometimes I feel SOB but its not constant.
Doctor :   Is your daily activity affected by your current BP fluctuation and SOB?
Doctor :   I mean the exercise, households etc
User :   when I walk and run Im not SOB at all...surprising as much out of shape I am. Seems more when I rest.
User :   SO that left atrial mean pressure, does that mean the atrial is enlarged or damaged. Im just trying to get healthy and understand some things
Doctor :   ECHO does not indicate an enlarged LA
Doctor :   so do not worry
Doctor :   In fact you are doing better as you do not have problem when you walk or run
User :   That could change though huh?? Whats my best bet here??
Doctor :   so you should feel great about yourself
Doctor :   Your next step would be to see if the dosage and timing of blood pressure medication has anything to do with the fluctuating BP, I mean can it be bettered with simple alterations
Doctor :   otherwise, keep continuing your exercise and continue your efforts to quit smoke
User :   Well, I work at 6pm at night and get off at 6am. I try to keep it around that time.
Doctor :   Thats better
User :   So dont worry about that mean pressure then??
Doctor :   No
User :   Have bad gentics on both sides of family and trying to controll it early. I already had to episodes of afib and second or touch up ablation.
User :   So trying to make changes in my lifestyle
Doctor :   That is always good
User :   Ok, then thank you for your time. Have some POTSD
Doctor :   Come out of stress as you are completely doing good
Doctor :   Stress is a very good reason for fluctuating BP
User :   Ok...Im trying really hard.
User :   Im a paramedic so sometimes knowledge is my worst stress
Doctor :   However keep a record of the BP recordings, the time of the day, the position and limb recorded etc
User :   Yeah, I have one of those going..
User :   Thank you
Doctor :   Pleasure here
Doctor :   Bye for now
User :   Bye
Doctor :   Hope your queries were answered
Doctor :   Hi
Doctor :   Are you back?
User :   yeah, some anxiety, but I had a question. Dang 15.00 for a question so help me out. My first ablation was in july of 2010. I had a LA mean of 12 then and now I have a mean of 15. Changes there??
Doctor :   Ok the LA pressure can fluctuate
Doctor :   after ablation
Doctor :   More importantly how is the LA pressure done?
Doctor :   Was it just ECHO
User :   Intra echo when they were inside the atrium
User :   does that make sense??
Doctor :   But these can happen, after ablation
Doctor :   more over just do not be bowled by LA pressure alone
Doctor :   The near accurate way of LA pressure is Pulmonary artery wedge pressure
User :   OK...So Blood pressure in the heart or systemic can be higher after ablation surgery??
Doctor :   so ECHO generated pressure can be easy way of taking but not the accurate
Doctor :   yes
User :   Ok, a wedge pressure woud be done by catherzation huh? not going that far but that would be the most accurate??
Doctor :   yes
Doctor :   Please do not worry for now
Doctor :   Carry on with yoru medication
Doctor :   and check up with your doctor
User :   Ok, just trying to understand things to help me make me better. Maybe im reading to much into it.
User :   ok thanks again..sorry to bother
User :   Do I get half back since this wasnt 30 minutes...LOL
User :   Hello
Doctor :   Oh
Doctor :   I am not aware of that
Doctor :   I am only a medical doctor
Doctor :   You can contact the customer care team
User :   ok
Doctor :   YYYY@YYYY
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