35 yr old female comes in crying, anxious, coughing. States her chest hurts. Hx of Graves disease. EKG shows SVT 240's. RR 40's, and BP 140's/100's.We get her ready for a dose of adenosine, doc walks in and starts asking his questions. She says she has felt like doo-doo for the past 2 days.
6mg adenosine without effect.
20mg diltiazem brings HR to 200.
5mg lopressor drops HR to 180.
She's on the pads, about to cardiovert, doc tells us to stop until we get a CT angio due to "risk of a clot" because "she's been like this for the past 48 hours. She has chest pain, she could have a PE."
she has been in SVT for the past 2 days. And I'm sure
her chest hurts cause she is throwing a clot, nothing to do with her HR or BP. And I bet she is in a thyroid storm.
1.5 hours later, after we get labs back and get the CT angio is negative, cardioversion is successful, she sits at sinus tach at 110 until she is admitted.
My question is: have you ever not
performed a cardioversion due to risk of a clot? I mean, we tried 3 different meds with limited success. No place else to go than cardioversion. I was upset we didn't cardiovert right off the bat.
BTW, this is the first time I have seen absolutely no effect from adenosine, and yes we gave it properly.
May 12, '13
by BostonFNP Moderator
I have seen CTs done prior to cardioversion for this reason.
Last edit by BostonFNP on May 12, '13