Diagnosis And Treatment of Arrhythmias Essay

Over this past weekend, I had a patient enter the emergency room because he thought he had COVID and wanted to be tested. We triaged him and found that his heart rate was 180. The patient had an extensive cardiac history, including an internal pacemaker/defibrillator. An EKG was performed and found that this patient was in Ventricular Tachycardia, a lethal, stress-induced cardiac channelopathy (Wleklinski et al., 2020). The defibrillator would not shock unless his heart rate exceeded 200. The patient had been shocked before and did not want this to be the first line of treatment, and we incorporated the patient preference into consideration. Hours began to pass, and several medication attempts failed, including Adenosine, Cardizem, and Amiodarone. At this point, two hours total since door time passed, and he said the famous phrase all nurses pucker at, “I do not feel so good.” While he begins perfusing sweating, I now cannot obtain a blood pressure. Let us just say the patient’s preference is no longer appropriate, and we must shock immediately. The shock was administered, and the patient was back into sinus rhythm. I also obtained a “decent” blood pressure while he slowly woke up. Considering the patient’s preference could have cost his life if we did not act fast enough. Diagnosis And Treatment of Arrhythmias Essay

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The patient’s preference was included in the treatment plan as he did not want to be shocked if necessary. Most physicians try medications first anyhow, so I also foresaw Adenosine as the first-line treatment. “Adenosine has been used in the emergency treatment of arrhythmia for more than nine decades” (Gupta et al., 2021). We were also questioning whether or not the patient was in a wide-complex tachycardia vs. ventricular tachycardia because he walked through the front door with no problem. Diagnosis And Treatment of Arrhythmias Essay

For my patient decision aid, I researched Heart Rhythm Problems: Should I Get an Implantable Cardioverter-Defibrillator (ICD)? Even though the patient already had a pacemaker/defibrillator, this would also be a good tool for patients with heart conditions that do not understand or are unsure about getting one. The aid gives information for patients to think about, including, “there are several risks to getting an ICD. Problems can happen during and soon after the surgery to implant the device” (A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute, 2022). I would be able to give this valuable tool to patients that may have questions about their specific concerns. Diagnosis And Treatment of Arrhythmias Essay

References

A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute. (2022). The Ottawa Hospital. Retrieved August 8, 2022, from https://decisionaid.ohri.ca/AZsumm.php?ID=1418

Gupta, A, Lokhandwala, Y, Rai, N, Malviya, A. (2021). Adenosine—A drug with myriad utility in the diagnosis and treatment of arrhythmias. J Arrhythmia 37: 103– 112. https://doi.org/10.1002/joa3.12453

Wleklinski, M.J., Kannankeril, P.J. and Knollmann, B.C. (2020), Molecular and tissue mechanisms of catecholaminergic polymorphic ventricular tachycardia. J Physiol, 598: 2817-2834. https://doi.org/10.1113/JP276757 Diagnosis And Treatment of Arrhythmias Essay