what would you do if this was your parent?
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My mom has SVT and has been converted 4 times in the last 2 years (with Adenosine anywhere from 1st to 3rd dose - never shocked). This just happened again last week. Rate was 242, converted on 2nd push. In the past, there has been something (sympathetic ANS stimulus) that brought it on - emotional stress, worry, got mad, etc. This time it happened without a 'cause" -- just out of the blue.
Mom is 56yoa, "light" SMOKER (believe me I am on her about that), had a CABG in 95 after stents failed. She is relatively sedentary. Has had a wedge resection for primary adenocarcinoma in 2001 (found on chest CT after car accident - found by accident: no chemo/xrt for stage I).
Her normal pressure is about 100/70 with HR of about 65. Only meds were diuretic (K+ sparing one - maybe misspelled - Spironolactone??) for CHF (again SMOKING:angryfire ). Takes Wellbuterin to help stop smoking (and makes her MUCH easier to live with!). Is on one of the statin drugs for high cholesterol (now CHOL = 180, but risk ratio is still over 5 and we have strong family hx)
Family Dr (who treated her while in hospital) started her 25mg of Topril and she brady'd down into the 40s!!!!!!!!!!!!!! (but was Normal Sinus Brady: no pauses, no arrests, no abnormal anything... but still - rate in the 40's does a number on cardiac output -- I would think -- right? That freaked me out a little). So, he cut dose to 12.5 and mom takes it at night. Between diuretic & B-blocker, her pressure is now in the toilet at about 70/55 and, imagine this, she has vertigo (ortho hypotension) when she has to get up and pee 6x night! Can you see how she is DRIVING ME CRAZY ????????
Now, We're waiting for FU with Cardiologist and I am sure they'll do a stress test. Mom lost medical insurance soon after lung ca and therefore no follow ups with cardio (just got medical ins. recently).
At what point do you start considering a pacer (IACD?). What should I expect to hear from cardio? What should I make sure to ask? What would you be concerned with if this was your mom? Also, she lives in a rural small town in the middle of no-where and EMS could take 15+ minutes to get there. When she called 911 they had her do valsalvia maneuver + take a Nitro while amb in transit to get there (I told her try carotid massage also next time to slow her rate while waiting for ambulance-- that ok????)
And sorry for the misspellings/wrong nomenclature. I work in transfusion services now (have worked in blood bank for 11 years -- start nursing school in Spring 05). Please don't water down any advice/terms -- if I don't understand the terms, I'll ask (after I try to look it up for myself -- that is how I have learned this much so far). We both know that sometimes the key to getting info out of the Drs is knowing what questions to ask!
thanks for any help!
Christine