# Interesting Cardiac call



## SoCal (May 2, 2011)

Just thought I'd share a call I ran recently. 

Got a Code 3 ambulance only call at 1300 to a Clinic for a heart problem. Onscene found a 80 y/o female lying on table. pt. c/o chest pain rated at 2/10 that began at approx 0530 am  and awoke her from sleep. pt. awoke and started to do some house chores when she got dizzy/ lightheaded along with the chest discomfort. clinic dr. has administered .4mg ntg that took her pain to 0/10, however still lightheaded and dizzy. asa withheld at clinic due to pt. on coumadin. 12-lead was taken with an underlying a-fib which is normal for the pt and uniform pvcs. clinic has a 22 ga. iv established pta. clinic has no o2 on her, spo2 96% RA. 

H- A-fib, pacemaker ( showing no pacer spikes on clinic EKG, our EKG or any 12 lead taken), htn
A- None
M- Long list including coumadin.

while assessing pt, noticed the monitor switch into all wide complex, uniform PVCs (run of slow V-tach at a rate of 70-80, otherwise accelerated idioventricular rythm), pt. PVCs were perfusing, no recurrence of chest pain however dizziness and "ill" feeling increased. A-fib was still underlying rhythm.

How would you treat? I will post up what I did later.


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## johnrsemt (May 2, 2011)

O2;  probably 4 l//m via N/C.  depends on your protocols from there.  Some can do Lidocaine for V-tach  (multiple PVC's)  other places can do 150mg Amiodarone.   
  You didn't give a B/P  but I would give a bolus no matter what the BP is;  some people get dehydrated and it can screw with their heart rhythm even if the BP is ok.


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## Veneficus (May 2, 2011)

SoCal said:


> H- A-fib, pacemaker ( showing no pacer spikes on clinic EKG, our EKG or any 12 lead taken), htn
> A- None
> M- Long list including coumadin.



The rest of the medications and history would be important for this.


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## bfog99 (May 2, 2011)

All uniform PVC's at a resonable rate with hx of pacemaker, are you sure it wasn't a paced rhythm?


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## SoCal (May 2, 2011)

^^ 
this call was a month or so ago, I can't recall all H,A,M. Just ran too many calls since then. Sorry.

B/P was 190/100, repeat B/P were all around 170/90 ish...

Like I said, pt. did have a pacemaker, however she had no pacer spikes on any of the 3 cardiac monitors she was placed on (clinics, EMS and hospitals) and she did have an underlying rhythm, an a-fib underlying with no pacer spikes mixed in on either rhythm.


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## enjoynz (May 2, 2011)

Ok just a wild stab in the dark here, but as none of the readings showed a spike,
could her pacemaker have run out of battery power and for some weird reason the heart was beating of it's own accord? 
As I said, I'm not sure if that is at all possible, but thought I'd throw the question in anyway.

Cheers Enjoynz


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## exodus (May 6, 2011)

Thank you for not pushing a drug for V-Tach..

http://www.epmonthly.com/clinical-s...e-the-slow-mimics-of-ventricular-tachycardia/

Edit: With that article, I may even push for hyperkalemia with your pt too, being in vegas and it being so hot, it could cause a slight case to get way worse.


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