Medical post
It's been a quiet call night - my junior doctor (S) did not call until 5am.
A young man (30 yrs) came with 7 1/2 hrs of chest pain and shortness of breath. S described the ECG; clearly he was concerned about a heart attack but felt like he was missing something. His instincts were right: although there were some signs of 'ischemia', or reduced blood flow, on the ECG, the primary issue was an arrhythmia - the heart was beating far too fast. This was not a clogged artery, but rather a heart that didn't have enough time between beats to get blood flow. The solution was to try and stop this arrhythmia (a Supra-Ventricular Tachycardia or SVT).
We tried several maneuvers to 'break' the SVT (culminating in dunking this dignified young man's head in ice water) but ultimately had to do synchronized defibrillation. We gave him some intravenous valium (so he wouldn't remember) and I handed the paddles to S. Everyone cleared back from the metal bed frame, S leaned in (looking a bit nervous), pushed the buttons, and.....THUB....for a very long 1 1/2 seconds there was nothing at all. I think S's heart may have stopped of the same length of time. Then the heart restarted, in normal rhythm, and the patient's chest pain rapidly receded.
When our hearts don't respond to the usual maneuvers, sometimes they need a shock.
It's been a quiet call night - my junior doctor (S) did not call until 5am.
A young man (30 yrs) came with 7 1/2 hrs of chest pain and shortness of breath. S described the ECG; clearly he was concerned about a heart attack but felt like he was missing something. His instincts were right: although there were some signs of 'ischemia', or reduced blood flow, on the ECG, the primary issue was an arrhythmia - the heart was beating far too fast. This was not a clogged artery, but rather a heart that didn't have enough time between beats to get blood flow. The solution was to try and stop this arrhythmia (a Supra-Ventricular Tachycardia or SVT).
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| You may be able to see the ECG tracing on the screen of the defibrillator |
When our hearts don't respond to the usual maneuvers, sometimes they need a shock.
It's like giving the heart a good spank for misbehavior, and it then decides it will behave.
ReplyDeleteyep, sometimes we need cold water, sometimes we need a shock, but we usually feel better afterward.
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