heart rate 40 ,SBP 60, for over an hour

Specialties Cardiac

Published

?Healthy?, 60ish year old male out patient surgery patient had a history of "vasovagal" episodes. Went from HR 70's, SBP 120's, to HR 38 - 40, SBP 60's. Patient said he was okay, just tired, he responded appropriately to me the whole time.

I notified anesthesia, he said, "Yeah, he has these vasovagal episodes, it just means the cardiologists don't know exactly why or what causes it, just watch him."

Long story short, I did no interventions except ran his IV wide open and kept him in slight trendelenberg. His vital signs stayed low for over an hour.

His wife is an RN, she came in and said, "Yeah he does this, it usually doesn't last this long, yeah he has been "worked up," he normally drinks a lot of water, he just needs more fluids."

Vitals returned to normal, he said he just felt tired, and went home. He said something about "they think my blood pools in my legs and forgets to pump back to my heart" as he was getting dressed. (I guess I could have, should have, put on SCD'S?) Called him the next day, he was fine.

Took about a week for my heart rate to return to normal!!!!

Have you seen anything like this?

Wouldn't some kind of pacemaker be indicated?

Specializes in Telemetry, Psych.

Sounds like you did the right thing. IVF's are a solid choice, and continuously monitoring, which it sounded like you did. The only thing that comes to mind is the documentation. "Physician notified re: bradycardia and hypotension. MD aware, no new orders given. Continuing to monitor the patient." Also as was mentioned, asking the MD if they have considered an EP consultation is a great idea.

Did your BP monitor tell you the MAP? The patient could have been fairly asymptomatic if his MAP was still 60 or above. MAP is generally an important reading in ICU, but is often forgotten about on other units. I've gotten several patient on pressure supporting meds due to telling the MD that I calculated the MAP and it was less than 60 and I was concerned that even if the patient was asymptomatic at the time, a prolonged time of a MAP less than 60 means vital organs are not getting perfused.

As someone with vasovagal syncope, this is an interesting thread to read! My first episode happened at home. I thought I was having a heart attack. Thank goodness my husband was home and called 911. Paramedics came and never could get my pulse or BP since both were extremely low. It wasn't until the ambulance got me to the ER that they were able to get my VS. I was completely out of it, lost bladder control, and remember feeling like I was floating outside my body watching what was going on. After 2 days in the hospital and all sorts of tests, I was cleared by my cardiologist and neurologist. I periodically have "episodes" but I've learned to recognize the signs and do what my neurologist told me to do: lay down and put my feet up no matter where I am. I've done that in Target a few times (their lights will sometime trigger an episode) as well as the mall and the grocery store.

Did your BP monitor tell you the MAP? The patient could have been fairly asymptomatic if his MAP was still 60 or above. MAP is generally an important reading in ICU but is often forgotten about on other units. I've gotten several patient on pressure supporting meds due to telling the MD that I calculated the MAP and it was less than 60 and I was concerned that even if the patient was asymptomatic at the time, a prolonged time of a MAP less than 60 means vital organs are not getting perfused.[/quote']

Good point. Honestly, MAP isn't really emphasized working on my unit (med/surg)..good to know though... thanks for bringing it up. I usually just ignore that number!

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