Post CABG, HR105= is it normal?

Flo., BSN, RN · May 30, 2011

What parameters did the doctor give you to call? If you are ever questioning if you should call, go ahead and call. Better to make a few unnecessary phone calls then to miss that one call that you should have made. Don't think about your ego, think about what is best for the patient.

azhiker96, BSN, RN · May 30, 2011

Is the tachycardia a new finding? How is his fluid balance? What are his labs? Is he in pain? Look at the total patient before you call. If you're prepared it makes for a short pleasant phone call. If the doctor has to wait while you look up labs or add up I/Os then it's not so pleasant.

Also consider meds which he has had recently. Some IV meds will cause a transient tachycardia if not pushed slowly.

I agree with Flo, it is better to call if you have a doubt than to put the patient at risk. Remember we are part of a team, you are the eyes and ears for the docs when they are not there. Some might get snippy but the good ones will appreciate the call and will help you learn and grow as well. BTW, talk to your coworkers or the team lead also. They are a great source of good advice and information.

Esme12, ASN, BSN, RN · May 30, 2011

You come here with a lot of these kind of questions.I am glad you ask questions but without seeing the patient it is extremely difficult to ascertain what to do........

Do you have a supervisor? A charge nurse? Any nurses with more experience than you? Is this long term acute care? Is the patient on a monitor? Is the pulse regular? What does the 12 lead show? Is the patient having pain? What parameters are established by the MD....examlple: Call for systolic B/p >160 or heart rate >110 (examples) ? are they dry? What is the patients I/O Is the patient having pain? Are they SOB? Are they hot? are they febrile? What is the normal underlying heart rate....?

Is the pulse is regular? If it is not, is it usually irregular. If a regular HR becomes irregular in a post CABG it need to be called to the MD or sent back to the hospital as Atrial fibrillation is a common post op arrythmia depending on how the patient was cannulated(tubes palced) to be palced on the bypass (heart/lung) machine. What meds are they on? Are they getting breathing treatments? Is the patient diabetic? what is their glucose? Post op CABG's are usually anemic.......they can have a Hct of less than 7 before most surgeons will transfuse ,unless symptomatic. Did the patient just finish voiding or going to the bathroom?

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A heart rate of 105 isn't very high. That can be from pain, slight dehydration, activity, digestion after a big meal, or elimination or just because they hot. When in doubt....call!

JulieCVICURN, BSN, RN · May 30, 2011

Yep, it depends on your patient. 105 is a normal heart rate for me all the time (86 resting)because I'm slightly anemic and I don't get as much exercise as I should, plus I'm on Adderall XR, which probably isn't slowing it down much either.

However, if it's not normal for your patient and it's a regular rhythm, it can be a fairly benign early warning of dehydration, low H&H, irritability of the heart. If this is a new finding, you need to call to get the doctor's opinion on whether or not the patient needs some medication for control. If it is an early warning sign, you don't want to ignore it and waffle about calling because you currently have time to fix whatever might be going on before things really start going south.

Jenni811, RN · May 30, 2011

I work on a cardiac unit and we get all the post-op cardiac patients, so LOTS of CABG.

To answer your question, i would have to say it depends upon the patient and if they are symptomatic. I wouldn't jump to conclusions if i saw a HR of 102-105. Patients can have some tachycardia when things are trying to regenerate. You got all these new vessels that were before occluded so now the heart is working to pump all this blood through these new vessels, get things working. So sometimes its not uncommon to see a faster heart rate, or to maybe hear some friction rubs (Different from tamponade!!!)

Anyway....what i'm not telling you not to call the physician, because it is totally up to you as the nurse. I've had a post-op CABG patient with the HR in the 120's and asymptomatic. i decided not to call physician because patient couldn't feel it/wasn't having any funky heart rhythms. I did make a note of it in the EMR and told physician on rounds.

CRNA1982 · May 31, 2011

I'm not so comfortable with any pt. > 40 y/o with a HR > 100 and I'm definitely not comfortable with a tachycardic pt. s/p CABG..... Even if we are dealing with fresh "wide open" grafts; tachycardia is not optimal. This is basic medical 101; tachycardia equals less time spent in diastole which equals less overall coronary perfusion. Often times, I can actually watch ST segment changes in pts. with CAD under an anesthetic during times of increased stimulation and tachycardia. The only way to treat these symptoms is to fix the underlying problem whether it be blood, fluid, narcotic or beta blockers. Try to think about what is causing the tachycardia and how it can be treated before "calling the doctor and following their order"