The other day, I came across a tilt table test on a patient. It was a young person who had been experiencing syncopal episodes and so was sent for the study. I was amazed to come across the phrase "patient lost consciousness and asystole was observed for 25 seconds, after which a regular bradycardic rhythmn returned."
Observed?:uhoh21: For twenty-five seconds?
I was floored and wondered if I was missing something. It could not have been a mis-transcribed word, because asystole was mentioned 2 more times and the context was correct all 3 times. I asked an anesthesiologist and he was as surprised as I, but was busy at the time and simply laughed and said "well, that was a long 25 seconds!"
The test did not have any relevance to the patient's care in my facility and in fact was historical so I didn't even bring it to anyone's attention. It had obviously been reviewed and had not raised any alarms with anyone (including the cardiologist who treated the patient at the time).
What am I missing? Is it normal (a) to experience asystole in a tilt table test, and (b) for the asystole to simply be "observed"?
Sinus arrest happens all the time. 25 seconds though would be scary... that's a LONG time. (It would definitely get MY heart beating faster). I think 16 seconds is my personal best and I was squealing like a little girl. Got lots of attention.
I see it every now and then these days when someone vaso/vagals and sometimes with accidental overdoses of Dig and Beta-Blockers (usually renal pt's) Asystole for that long and the crash cart is going to be at bedside for the rest of the visit. Pace-Paddles at the ready...
roser13, ASN, RN
6,504 Posts
She was being worked up for syncopal episodes. No treatment given that I could find documented, just the "observation."
Eventual diagnosis from cardiologist, according to patient: vasovagal syncopy, expected to be outgrown (patient was teen at the time).