V tach leading to an MI

SwansonRN · Feb 6, 2014

MI is death of cardiac muscle s/t prolonged ischemia...did you mean cardiac arrest instead?

AJJKRN · Feb 6, 2014

Absolutely! Anything that can or is compromising the O2 needs of the heart can precipitate an MI regardless of how the question was worded. (in which I personally did not see any problem with)

Emergent, RN · Feb 6, 2014

Can a patient who has short runs of v tach be at risk for an MI and could it be a warning sign of an impending of an MI?

Runs of V-tach can indicate that the heart muscle is irritable. That can most certainly be the result of an ongoing MI. It also happens post reperfusion , such as when the heart muscle is reperfused by cardiac catheterization and stenting.

Short runs of V-tach won't usually cause what is called a 'Demand MI'. A Demand MI is when something causes muscle injury to the heart other than occlusion of the coronary arteries. Something such as profound hypotension, where not enough blood was available for pre-load to allow the coronaries to deliver enough blood to the heart muscle.

psu_213, BSN, RN · Feb 6, 2014

I would definitely be concerned that the runs of V tach are a sign of an evolving MI. Not so much that it would cause an MI.

Esme12, ASN, BSN, RN · Feb 6, 2014

Can a patient who has short runs of v tach be at risk for an MI and could it be a warning sign of an impending of an MI?

It is a serious warning that something bad is going to happen. While that may not be a "MI" is may lead to cardiac arrest.

Why is the patient having these runs of VT. It is a signal that the heart is VERY UNHAPPY and ANNOYED! So you ask yourself questions. What are the electrolytes. What is the potassium and Mag? Why are they having this arrhythmia? Are they predisposed to VT? Have they had this before? Is there are reason the heart is irritated? Do they have a central line/temp pacer irritating the ventricle.

VT is really never a "good" thing and should be a cause for alarm. However there are patienst who are KNOWN for VT and have internal defibrillators for this very reason.

Katniss88 · Feb 7, 2014

This pt had a history of one MI and three stents. He was in the hospital for a non-cardiac issue. He had surgery that day and he was doing okay when I received report and and was doing well when I did my assessment and during my rounds, early in the morning he had one short run of v tach and then went back to NSR. The charge nurse knew about this, but didn't feel like I should call the dr since the pt converted back to NSR and the pt wasn't complaining of any symptoms. Another time, a few hours later he had an even shorter run of v tach and again went back to NSR and the pt was fine. I informed the charge nurse, and the nurse said it was fine as long as he converted back to NSR. The rhythm strips of both V tach episodes were place in the chart and flagged.

The pt was scheduled to have a groshong placed that day, during change of shift I made the oncoming nurse aware of the two episodes of v tach and I even wrote it on my report sheet that I gave to her to keep. When I came back for my shift the pt had the groshong placed, and I asked the nurse if the pt had any episodes of v tach, she said no and that the pt was doing well.

I went about my normal routine and went to assess the pt. He had no complaints and no chest pain, vital signs were stable. He was alert and oriented, talked to me and seemed to be doing fine. About an hour and a half later, all of a sudden he started complaining of chest pain. Another nurse and I went down to the room to assess the pt, the other nurse ordered a stat ekg and cardiac labs. The ED Dr. ordered nitroglycerin tabs and 325 mg aspirin, I feel as if I didn't get the aspirin to the pt in time to make a difference. The hospital I work at doesn't have a cath lab, so we were awaiting a transfer to another hospital, before EMS got there the pt coded and didn't make it. The Dr said the pt had an acute MI. This was the first code I have experienced and the first pt I have had to die. I feel like I am somewhat responsible, maybe I should have called the Dr that night to make them aware of the v tach and maybe the pt wouldn't have had an MI. Now the supervisors are reviewing the code and asking those involved their side of the story. I don't know if every hospital has the same policy, but I can't help but feel like I am on trial and have to defend my actions when I already feel like I did so many things wrong.

RNGriffin · Feb 7, 2014

Post MI, your major concern is dysrhythmias, in particular your tachy rhythms. What seems to have occurred, and I can not provide too much detail without knowing the course of treatment is HF or MI-extension. You'll notice some patient tolerate post MI dysrhythmias better than others. Depending on the tx course, whether the physician ordered fibrinolytics etc. you'll note patients have short runs of ventricular dysrhythmias as the arteries are reperfused.

The main thing you are worried about with V-tach( at least I am) is Heart failure. When you think of any tachycardias, you have sufficient atrium return but decreased output. Your patient sounds as if there were fragmented clots from previous therapy that aspirin would not prevent from dislodging. Therefore, even if you did administer aspirin in time you would not have prevented further damage to vessels if there was already clot formation.

Rule of Thumb, consecutive runs of v-tach in a 2hr period should be reported to the physician not the charge nurse.

SwansonRN · Feb 7, 2014

I would let the doc know next time about the runs of v tach. Document that you notified the MD and then document your assessment/intervention ie "telemetry showed 10 beat run, Dr. Smith notified, pt denying chest pain, vitals unchanged, will continue cardiac monitoring". This way your butt is covered. If someone were to look into this patient's chart they'll see this patient was having ectopy and it wasn't followed up on.

Esme12, ASN, BSN, RN · Feb 7, 2014

This pt had a history of one MI and three stents. He was in the hospital for a non-cardiac issue. He had surgery that day and he was doing okay when I received report and and was doing well when I did my assessment and during my rounds, early in the morning he had one short run of v tach and then went back to NSR. The charge nurse knew about this, but didn't feel like I should call the dr since the pt converted back to NSR and the pt wasn't complaining of any symptoms. Another time, a few hours later he had an even shorter run of v tach and again went back to NSR and the pt was fine. I informed the charge nurse, and the nurse said it was fine as long as he converted back to NSR. The rhythm strips of both V tach episodes were place in the chart and flagged.
The pt was scheduled to have a groshong placed that day, during change of shift I made the oncoming nurse aware of the two episodes of v tach and I even wrote it on my report sheet that I gave to her to keep. When I came back for my shift the pt had the groshong placed, and I asked the nurse if the pt had any episodes of v tach, she said no and that the pt was doing well.
I went about my normal routine and went to assess the pt. He had no complaints and no chest pain, vital signs were stable. He was alert and oriented, talked to me and seemed to be doing fine. About an hour and a half later, all of a sudden he started complaining of chest pain. Another nurse and I went down to the room to assess the pt, the other nurse ordered a stat ekg and cardiac labs. The ED Dr. ordered nitroglycerin tabs and 325 mg aspirin, I feel as if I didn't get the aspirin to the pt in time to make a difference. The hospital I work at doesn't have a cath lab, so we were awaiting a transfer to another hospital, before EMS got there the pt coded and didn't make it. The Dr said the pt had an acute MI. This was the first code I have experienced and the first pt I have had to die. I feel like I am somewhat responsible, maybe I should have called the Dr that night to make them aware of the v tach and maybe the pt wouldn't have had an MI. Now the supervisors are reviewing the code and asking those involved their side of the story. I don't know if every hospital has the same policy, but I can't help but feel like I am on trial and have to defend my actions when I already feel like I did so many things wrong.

All codes are reviewed. At least where I have worked. These are process oriented to learn and go forward. All deaths within 24-72 hours of a procedure are reviewed as well.

I think the runs may be coincidental and I would think the MD would have seen the runs on daily rounds. As you go forward I would call all runs of VT to the MD. I am curious why the charge nurse didn't feel it was necessary to call the MD. How many beats of VT did the patient have each time? Arrythmias indicate that the heart is irritated and the MD might not have even treated the VT and just "watched it"

The ASA is meant to help survive a MI but does little to prevent one. The patient might have benefited from thrombolytics...however they are contraindicated as he just had surgery....that complicates things.

The VT was an indication that the heart was irritated....but the MI was going to happen regardless.

Patients get sick, patients die...in spite of what we do. ((HUGS))

ADeks · Feb 7, 2014

On my old tele floor we wouldn't call asymptomatic episodes of VTach until morning. Usually the docs would have an order of "notify if 10 beats or more. " But I would also chart every time on that patient. Stating pt denies chest pain or shortness of breath. Also in the morning I would chart that I notified the cardiologist.

Esme12, ASN, BSN, RN · Feb 7, 2014

On my old tele floor we wouldn't call asymptomatic episodes of VTach until morning. Usually the docs would have an order of "notify if 10 beats or more. " But I would also chart every time on that patient. Stating pt denies chest pain or shortness of breath. Also in the morning I would chart that I notified the cardiologist.

Whoa!

I need to jump in here. You do realize that saying "the doctor told me" is not absolution from responsibility in COURT OF LAW. Because the doctor does not "want to be disturbed" at night-will not absolve you of responsibility. The FIRST thing that MD will do, especially without a written signed order is say...."THAT is NOT what I meant!" and the facility will not have a "policy" that states this as procedure for "emergent" arrhythmia notification (believe me there won't be) and the nurse will be sold down the river!

Even with an order...not notifying the MD can result in you(not you you the collective you) being in BIG trouble if something REALLY bad goes down and the family/patient sues! If there is ONE other "reasonable and prudent nurse" who would call...your goose is cooked.

It makes me angry that physicians act this way especially in small rural facilities where the are nothing but a guppy in a puddle making them appear to be a whale amongst minnows. NOTHING gets under my skin more. These MD's need to get over themselves and do their jobs!!! Pompous ass.

I can be sued for NOT calling the MD. But I can't be sued because I called and made the MD angry. If I lose my job becasue of the angry doctor I'd sue and move on as this was NOT the facility to work in from the start.