Any known connection between urination and VT?

Specialties CCU

Published

I work in a CCU stepdown, almost everyone has an electrical problem. I've been on the unit for almost a year (new to practice) and I can't count the number of times someone has a run of non-sustained VT and as the nurse heads to the room he or she says, "I bet she's peeing again."

A couple days ago a patient was peeing, went in to SVT @ 160, then VT to 240, coded and died.

This motivated me to finally ask the question...

...Is there a connection between urinating and arrythmias? First off, does anyone else see this all the time like i do?

Second, here's my only guess...It makes sense that given all the diuresis and antihypertensives, postural hypotension would be an issue for many heart patients. And when patients stand to pee, the normal physiologic response - an increase in HR - is exaggerated because of this orthostatic hypotensive state. And if this patient is also predisposed to tachyarrythmias, this exaggerated increase in hr (and maybe even the volume shift) sets off the arrhythmia.

This is my best guess but I'm sure one of you smarter people have the ACTUAL answer (assuming that this phenomenon is not just unique to my floor).

Thanks for any insight you can offer

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Specializes in CICU.

Well, there is the poorly understood Pee-tach, which isn't an arrhythmia at all...

I don't know about any science behind it, but could it be related to the infamous "last poo" or "last turn"? Anyway, your guess sounds good to me.

In all seriousness, if someone had a run every time he stood to pee - I wouldn't let them stand up...

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Specializes in critical care.

I have never heard of this. Makes me thankful I'm an ICU nurse and 90% of my patients have foleys! Ok, maybe not 90%, but very few actually get up and walk to the bathroom, and absolutely NOTA.. . No One Toilets Alone!

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Specializes in Complex pedi to LTC/SA & now a manager.

Not a critical care nurse but could it be related to vagal nerve stimulation? Usually associated with defection but some people bare down when urinating. I witnessed this a few times as a EMT & ED Tech years ago

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Specializes in Emergency, Telemetry, Transplant.
Not a critical care nurse but could it be related to vagal nerve stimulation?

I was thinking the same thing...that a person vagals when they are actually in the act of voiding. However, I do like the orthostatic theory when a patient stands to urinate.

Does this connection apply to both men and women? Does it happen when they stand to go or when they are actually going?

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I was under the impression the vagal response DECREASED heart rate. A vagal response (valsalva maneuver) can be used to stop SVT, right? Help me out here, cardiac people.... Maybe I should ask Dr. Google.

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My understanding od vagal response is also a decrease in HR.

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Specializes in Complex pedi to LTC/SA & now a manager.

It's my understanding (based upon my very limited, anecdotal experience and recent research out of curiosity) that neurocardiogenic responses may affect the heart rate (arryrhmias, tachycardia or bradycardia) differently but generally cause hypotension. So depending on the patient they may have SVT but the hypotension is the bigger problem. Next patient may brady & have hypotension...

From the journal articles I read, current thought that the neurocardiogenic response is genetically determined hence why a vagal maneuver will stop SVT in patient X but make the SVT worse in patient Y requiring pharmaceutical intervention or cardio version.

From what I've seen & read not everyone with tachycardia is also normotensive or hypertensive depending on the cause of the tachycardia.

I found a couple of abstracts but the links aren't copying right on my phone.

Again I am neither a cardiac nor critical care nurse but I have seen bizarre idiosyncratic reactions to vagal stimulation in my favorite pediatric client who happens to be a medical unicorn/zebra. This child has stumped many world renowned specialists with his unique, unexpected abilities. & disabilities.

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Specializes in Cardiac Medical, ICU, ED, Intermediate,.

Micturation syncope! Google it and check out wikipedia. I'm a cardiac medical nurse and this can and does happen.

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Specializes in pediatrics, geriatrics, med-surg, ccu,.

I agree with nursecounselor. When the person has a full bladder and they empty 1/2 to 3/4 of the bladder, what happens with this is that the heart rate begins to accelerate, the pulse pressure and mean arterial pressure decreases, the person becomes dizzying/syncopal episode happens. For the most part they say it happens mostly in healthy individuals but have seen it happen in ill persons as well.

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I was thinking the same thing...that a person vagals when they are actually in the act of voiding. However, I do like the orthostatic theory when a patient stands to urinate.

Does this connection apply to both men and women? Does it happen when they stand to go or when they are actually going?

In my experience, it's more men than women that get the "pee-tach" (love that) and in many cases the patients are merely sitting up in bed, not necessarily standing to pee.

As an aside, brushing teeth is another adl that creates a convincing VT on the monitor. It looks so real that I'm starting to believe that brushing teeth causes VT (as opposed to the prevailing notion that the jostling of the tele electrodes while brushing causes an artifact that looks like VT).

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I had the most beautiful V Tach on the monitor I had ever seen....when the code team ran into the patients bathroom he was standing there with a mouth full of toothpaste....tele leads draped over his... arm and was vigorously brushing his teeth with an up and down motion....producing a beautiful VT. He looked at us in surprise and asked through the toothpaste foam...what's the matter????

Micturation arrhythmia's occur...while the most common is bradycardia and syncope....in some cases the same mechanism that causes vaqal stimulation/autonomic nerve function causes a re-entry phenomenon precipitating tachy arrhythmia....add that to a prolonged QT, irritated myocardium and viola .....V tach.

It is more common in men as they strain to urinate around an enlarged prostate.

http://www.hrsonline.org/Patient-Resources/Symptoms-Diagnosis/Fainting/Treatment-for-Syncope#axzz2jxSIhL00

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