I have looked through my books a bit and browsed google some and am still fuzzy on the physiological process by which the extra pressure that CPAP can cause on the heart can cause electrical changes on the EKG, massive ones at that. Below is several 4 leads and 12 leads with some patient information, I am curious on your thoughts on what is going on...
57 year old female, history of cardiac problems, implanted A-V pacemaker, COPD, and CHF. Lung sounds are minimally wet and from description of patient upon arrival this seems to be more COPD exacerbation than CHF. No edema noted in lower extremities. Patient GCS 15 upon arrival breathing 24-28 times a minute, very shallow, with a pulse ox on home O2 of 84% while resting.
Initial vitals
BP 226/140
HR 81
Respirations 24-28
O2 84% on home O2 while resting
First 4 lead and 12 lead were obtained at the same time (within 30 seconds).
CPAP was placed 1-3 minutes after EKG obtained. 5-7 on the pressure
Second 4 lead and 12 lead were obtained 7 minutes later.
Patients work of breathing and O2 sat Improved dramatically shortly after placement of CPAP. Patient was comfortable upon arrival to hospital.
So Im wondering about these EKG changes and the process by which this occurs...and how worried do I need to be when I see this...
In order,
First 4 lead
First 12 lead
7 Minutes later
Repeat 4 lead
Repeat 12 lead
57 year old female, history of cardiac problems, implanted A-V pacemaker, COPD, and CHF. Lung sounds are minimally wet and from description of patient upon arrival this seems to be more COPD exacerbation than CHF. No edema noted in lower extremities. Patient GCS 15 upon arrival breathing 24-28 times a minute, very shallow, with a pulse ox on home O2 of 84% while resting.
Initial vitals
BP 226/140
HR 81
Respirations 24-28
O2 84% on home O2 while resting
First 4 lead and 12 lead were obtained at the same time (within 30 seconds).
CPAP was placed 1-3 minutes after EKG obtained. 5-7 on the pressure
Second 4 lead and 12 lead were obtained 7 minutes later.
Patients work of breathing and O2 sat Improved dramatically shortly after placement of CPAP. Patient was comfortable upon arrival to hospital.
So Im wondering about these EKG changes and the process by which this occurs...and how worried do I need to be when I see this...
In order,
First 4 lead
First 12 lead
7 Minutes later
Repeat 4 lead
Repeat 12 lead