"Heart keeps skipping a beat"

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Explorer127

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57 y/o female pt
Only past medical history is lupus.
No allergies
Only med pt is on is Advil...
Last oral intake--nothing out of the ordinary..
Events Prior--Once again, nothing that could provoke symptoms.

Pt states that she often feels heart skip a beat once or twice every day.

However, today it happened every 3-5 minutes for about 30 minutes every hour. States that often when it happens, she feels dizzy and everything around her "turns red." This continued for a few hours.

Pulse 88
BP 136/80 (her normal)
Whenver I take her pulse, it would be pretty regular, suddenly stop (the skipped beat) then continue and be somewhat tachy, then go back to normal.


Never got to find out what happened---any ideas?
 
Explorer127 said:
57 y/o female pt
Only past medical history is lupus.
No allergies
Only med pt is on is Advil...
Last oral intake--nothing out of the ordinary..
Events Prior--Once again, nothing that could provoke symptoms.

Pt states that she often feels heart skip a beat once or twice every day.

However, today it happened every 3-5 minutes for about 30 minutes every hour. States that often when it happens, she feels dizzy and everything around her "turns red." This continued for a few hours.

Pulse 88
BP 136/80 (her normal)
Whenver I take her pulse, it would be pretty regular, suddenly stop (the skipped beat) then continue and be somewhat tachy, then go back to normal.


Never got to find out what happened---any ideas?
Click to expand...


Sounds like she's was getting PVCs.

Did you hook her up to a 4 lead by chance? 12 lead?
 
No EKG was obtained b/c ALS was not available.
 
Several things can be going on with many different etiologies.

She may actually have experienced an MI recently that has yet to be diagnosed which can now be causing electrical distrubances.

She may also have an undiagnosed cardiomyopathy which could now be symptomatic.

Only past medical history is lupus.
Click to expand...
This is VERY significant for history as it affects many systems including the kidneys or renal system.

She could have an electrolyte imbalance cause electrical disturbances.

Did she have a history of smoking? She could now have an undiagnosed COPD which may already be presenting with cor pulmonale and rhythm disturbanes such as WAP or MAT.

Her dizziness may be from the irregularity in perfusion from the missed beats.

Did you listen for heart sounds?

An EKG? That would be the only way to know exactly what the rhythm is. She may also need to wear a Holter Monitor for 24 - 48 hours to determine rhythm disturbances or to be admiitted to a telemetry unit in the hospital for continous monitoring.

The missed beats could be PVCs, PACs, runs of PSVT, VT or tachy-brady associated with SSS which would get her a pacemaker.
 
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Are EMT's there not allowed to do 4 lead or even 12 leads? it is standard practice here, whether ALS is there or not (most often they are though). If ALS is not able to come, we still attach a 12 and send it from the montior (heartstart MRX which has wireless capabilitys) to the recieving facility for interp.
 
Kentia said:
Are EMT's there not allowed to do 4 lead or even 12 leads? it is standard practice here, whether ALS is there or not (most often they are though). If ALS is not able to come, we still attach a 12 and send it from the montior (heartstart MRX which has wireless capabilitys) to the recieving facility for interp.
Click to expand...

And then what?
 
i have the same problem. my heart skips beats multiple times daily, never got it checked out till i started having chest pain. my doc said my 12 lead was regularly irregular. all my labs came back normal. i thought that it was my thyroid acting up cause the time before that my thyroid levels were high. had to get an echo done and my doc said that my mitral valve is regurgitating and that i have some fluid build up around my heart.
 
I get skips too, don't get target fixated.

The pt sensing "skipped beats" is hardly diagnostic, it is historic. She could be arrythmic at other times and not know it. EKG is needed, but other areas cannot be ruled out, e.g., atrial fib and tossing clots, the pt senses these missed beats due to s/s of intracranial circ issues, etc. "Everything turning red" can be either too much intracranial pressure or too little venous outflow from the cranium (a "red-out") or too little perfusion (maybe even some sort of vaso-vagal episode). I'll bet she also heard a roaring sound in her ears.

As always, obviously needs to be worked up in a hospital, cut to the chase and get 'er in.
 
/me sighs.

Vent, don't you know, it's never lupus...


/house reference.
//had to be done.
 
AnthonyM83 said:
Course, it's always disseminated intravascular coagulapathy, right?
Click to expand...

No its not lupus or DIC. And its not Wegners ether, in case you were wondering.

JP, get a stress test
Anthony, go ultrasound her heart and look for valve problems
Vent, bleed the patient and spin the blood, find out if she has been eating her bananas.

I am going to sit here and watch my soap.
 
daedalus said:
No its not lupus or DIC. And its not Wegners ether, in case you were wondering.

JP, get a stress test
Anthony, go ultrasound her heart and look for valve problems
Vent, bleed the patient and spin the blood, find out if she has been eating her bananas.

I am going to sit here and watch my soap.
Click to expand...

Hmph.

10chars
 
You missed House's versin of a "subspace field":

"Paraneoplastic syndrome".

OP, any followup for us?;)
 
While you're at it, get her an MRI, since I know you're going to do it behind my back, anyway. And order the experimental treatment...make up some false lab reports for her.
 
AnthonyM83 said:
While you're at it, get her an MRI, since I know you're going to do it behind my back, anyway. And order the experimental treatment...make up some false lab reports for her.
Click to expand...

But what about Cuddy?
 
By the way, systemic lupus causes tachycardia, chest pain, and dyspnea in up to 50% of cases. Periods of tachycardia can certainly seem like SSS, SVT or skipped beats (palpitations). Women are more likely than men to get lupus (autoimmune). And as Vent has said, a significant sequelae of SLE is renal failure. Remember that kidney problems wreak havoc on electrolyte and fluid balance.

Lupus would definitely be in your ddx for this patient as the cause of her symptoms. Along with old/new MI, electrolyte issues, etc etc.
 
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