There was a 30y/o solider admitted for trauma, with broken humerus. He had been there about 24 hours and they decided to take him to the OR (same day as they did the bedside procedure on the post below this one). As they wheel him back and hook him up to the monitor they notice his heart rate is 200! So they appropriately wheel to the ICU and call Dr. Habib. I happened to walk by and notice them hooking up an EKG to a "new" pt in ICU. When I realized what happened, I asked if he noticed his heart beating fast and how long this had been happening. He stated yes, and it had been happening since last night constantly, no other symptoms. He then went on to say he has had this on and off again for a year. Of course no one got an EKG last night, it probably was never reported. Also, no one ever got a pre-op chest xray (CXR), but an xray of the bone. Prior to them hooking him up to an EKG or monitor in the ICU, I started to examine him. At first I thought he had afib because his pulse was irregular, but when I saw the monitor, I felt it again, and realized that his pulse disappeared everytime he breathed in! The first thing I thought was this guy had been in an MVA and maybe had tamponade, but he looked too good. His heart sounds were kinda distant, but not that bad. The rest of his exam was normal, no signs of heart failure. He converted back to normal sinus rhythmn (Second EKG) after 5mg of iv metoprolol (works on the heart to slow it down). His CXR showed a large heart. We did a quick ultrasound of his heart to make sure there was no fluid, which there was not. I told Dr. Habib, I thought this might have been AVNRT and he might have a tachycardia induced cardiomyopathy. I am trying to get in touch with the Italian docs and see if they have a cardiologist who could teach us how to do a good bedside echo, we have the equipment. For my fellow medicine friends, I am interested in what you think of the EKGs and CXR (keep in mind it is an AP, not a PA) but we did redo a PA and lat CXR the next day and it shows an enlarged heart without evidence of CHF. You can post your thoughts under this post. Thanks! To be honest, it has been a while since I have thought about some of this stuff, and I do not feel all that competent anymore, so I appreciate your input.
There was a 30y/o solider admitted for trauma, with broken humerus. He had been there about 24 hours and they decided to take him to the OR (same day as they did the bedside procedure on the post below this one). As they wheel him back and hook him up to the monitor they notice his heart rate is 200! So they appropriately wheel to the ICU and call Dr. Habib. I happened to walk by and notice them hooking up an EKG to a "new" pt in ICU. When I realized what happened, I asked if he noticed his heart beating fast and how long this had been happening. He stated yes, and it had been happening since last night constantly, no other symptoms. He then went on to say he has had this on and off again for a year. Of course no one got an EKG last night, it probably was never reported. Also, no one ever got a pre-op chest xray (CXR), but an xray of the bone. Prior to them hooking him up to an EKG or monitor in the ICU, I started to examine him. At first I thought he had afib because his pulse was irregular, but when I saw the monitor, I felt it again, and realized that his pulse disappeared everytime he breathed in! The first thing I thought was this guy had been in an MVA and maybe had tamponade, but he looked too good. His heart sounds were kinda distant, but not that bad. The rest of his exam was normal, no signs of heart failure. He converted back to normal sinus rhythmn (Second EKG) after 5mg of iv metoprolol (works on the heart to slow it down). His CXR showed a large heart. We did a quick ultrasound of his heart to make sure there was no fluid, which there was not. I told Dr. Habib, I thought this might have been AVNRT and he might have a tachycardia induced cardiomyopathy. I am trying to get in touch with the Italian docs and see if they have a cardiologist who could teach us how to do a good bedside echo, we have the equipment. For my fellow medicine friends, I am interested in what you think of the EKGs and CXR (keep in mind it is an AP, not a PA) but we did redo a PA and lat CXR the next day and it shows an enlarged heart without evidence of CHF. You can post your thoughts under this post. Thanks! To be honest, it has been a while since I have thought about some of this stuff, and I do not feel all that competent anymore, so I appreciate your input.
Any murmurs? Viral cardiomyopathy that decompensated with injury?
ReplyDeleteYeah his heart does look big. As for the EKG, with the rate at 200 and slightly widened QRS, it fits with AVNRT or AVRT. It doesn't look like he has a short PR or preexcitation. Let us know what the echo shows if you ever get one.
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