Quieter Korotkoff sounds when taking blood thinners?

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Discussion Overview

The discussion centers around the observation of quieter Korotkoff sounds during blood pressure measurement in a patient recently placed on blood thinner medication. Participants explore potential reasons for this phenomenon, including physiological changes and other medical considerations.

Discussion Character

  • Exploratory
  • Technical explanation
  • Debate/contested

Main Points Raised

  • One participant notes a significant reduction in the volume of Korotkoff sounds after the patient started blood thinners, questioning if this is a known effect of such medications.
  • Another participant reports a lack of direct information from medical literature regarding blood thinners and Korotkoff sounds, suggesting the need for further medical opinion.
  • A non-medical perspective is offered, proposing that reduced blood flow due to upstream vascular restriction could lead to quieter sounds, likening it to a low-pass filter effect.
  • One participant mentions decreased vascular compliance as a potential cause for the observed phenomenon, while also expressing concern about the quick onset of this change in the patient.
  • A clarification is made that blood thinners do not actually "thin" the blood but rather limit clotting ability, suggesting that dietary changes might also play a role in the patient's condition.
  • A suggestion is made to investigate the concept of an auscultatory gap as a possible explanation for the findings.

Areas of Agreement / Disagreement

Participants express uncertainty regarding the relationship between blood thinners and Korotkoff sounds, with no consensus reached on the underlying causes or implications of the observed changes.

Contextual Notes

Participants acknowledge the possibility of other medical factors influencing the observed Korotkoff sounds, but specific assumptions and dependencies on definitions remain unresolved.

berkeman
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I have a patient that I have known for a long time, and her Korotkoff sounds have always been pretty typical in volume when I've taken her blood pressure. But after a recent medical incident, her doctor has put her on a long-term blood thinner medication.

I was taking her BP a couple of days ago, and her Korotkoff sounds were so faint that I had to end up just taking the BP by palpation. Her systolic pressure was still typical for her (around 126/P), so I don't think that was the issue with the sounds being so quiet. Does anybody know if using blood thinners can result in quieter Korotkoff sounds when auscultating BP? My Google-foo is failing me...
 
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I find nothing on Medline, JAMA or NIH directly. Also tried drug names and "brands", examples: Warfarin, Xarelto, Heparin, and Dabagatran. Zilch.

The bad news is there are hits for other causes. As in: it is definitely possible you should consider getting another medical opinion before you write it off. ...like you did not already know this :smile:
 
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From a non-medical standpoint, it sounds like there is reduced blood flow - perhaps from an upstream restriction. With normal vasculature downstream of a constriction, this would also effectively implement a low-pass filter. (in electrical or mechanical terms, a resistance followed by a compliance.)
Probably @boneh3ad or @Chestermiller can give better insight though.
 
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jim mcnamara said:
The bad news is there are hits for other causes. As in: it is definitely possible you should consider getting another medical opinion before you write it off. ...like you did not already know this
Yeah, I need to look into other causes. Decreased vascular compliance looks to be a candidate:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800516/

Except for the quick onset of it in this patient. I'll check her a few more times to be sure, and have her mention it to her doc. Thanks for the help guys. :smile:
 
berkeman said:
But after a recent medical incident, her doctor has put her on a long-term blood thinner medication.
Blood thinner doesn't really thin the blood, it limits the ability to clot, so that shouldn't have a direct effect.
( Perhaps, in addition her diet has changed, and she is on a more liquid intake, which should find its way into the bloodstream )

Have you investigated the
https://en.wikipedia.org/wiki/Auscultatory_gap
as a route to your findings.
 

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