#weinkebach

Yesterday I was floated to the PCU (Procedural Care Unit)... the unit takes care of patients that have had heart caths, ablations, ERCPs, and biopsies (really any procedure where the patient will be in and out the same day or maybe the next morning).

So, I've finished getting report on everyone and have assessed my first patient. As I exit their room I look up at the tele monitor and I see that a patient's heart rate is in the 190s and the computer program is calling it v-tach. Well, fuck. I call to another nurse, everyone from day shift is still there, about the rhythm and rate. 

Instant MET call. It turns out the patient had gone in for an SVT ablation. We determined later that he was indeed in SVT, not v-tach. Either way... this guy's heart was beating like he was being chased by an angry bear and something needed to be done. 

Over the next few hours, with several diltiazem pushes, the patient was in and out of SVT. The highest his heart rate ever got was 220. Yikes. Finally, after 4-5 hours of these shinnanegans (he was in and out of SVT, mostly in, though the moment a doctor came by he'd flip out of it again) and a talk with the on-call cardiologist the patient got his normal home dose of PO diltiazem. 30 minutes later... sinus rhythm in the 80s, though regularly in bigeminy and trigeminy also. But, hey, that's better than a heart rate of 200, right?

So, he's finally able to rest and go to sleep. Fastforward a few hours... heart rate starts dropping into the 30s. He apparently has a known Weinkebach heart block. So now he's in Weinkebach in the 50s and sometimes down to the 30s. Then one of the times he drops to the 30s I noted that he has a Mobitz II block also. 

I mean wow. I think that is probably the most extreme variation of heart rate I've seen one patient in a shift. 

Madness.

The guy was fine... ended up being discharged as I was coming on shift tonight. The SVT was nothing new for him and obviously his home medication was what he needed to control it. 

Tonight I'm watching a guy that has been in trigeminy most of the night after his cath. BUt over the last couple hours he's been going more into sinus rhythm, but is having couplets, triplets, and 4-beat runs of PVCs.