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

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WOW !!!! I really don't know what to tell ya. I don't work in the cardiac field. I would tell the cardiologist just what you said here, it sounds like new medicines need to be tried to futher stabilize her. It makes it very hard when living in a rural area to get the care and answers you need. Keep searching until you get the answers you need and feel good about. I know from personal experience you have to keep looking and demand answers. There are good doctors and bad doctors, advocate for you and your mom until you get the right answers. Sorry I was'nt any more help, hope all goes well.

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Your mother needs some sort of insurance, government if possible, she may qualify as a dependent. Unfortunately after lung cancer and heart surgery your mother is still smoking, she should know better never to want to go through those things again. You need to have a deep talk with your mother and I'm sure you have. She doesn't seem to want to listen. I don't want to sound harsh but it may come out this way, she is being selfish. I told my own mother this after still smoking with heart problems, I told her I didn't want her to die in an ICU and how selfish of her to continue these habits.

All I can say is that your mother's heart is sick and you should ask every question possible to the cardiologist and encourage your mother to take control of her medical care.

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I forgot to mention, good luck with everything. Don't beat yourself up too much, children always take their parents health problems as their fault for not preventing more. Don't do that to yourself, I try not to do it with my mom, she won't listen to me and it makes me clench :angryfire. But she's an adult.

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well, i hoped to get more than 2 responses, but thanks to the two who did reply. we go to see the cardiologist today.

jewel - i do give gentle suggestions to my mom about the smoking...but you know what that is like. she is a grown woman, anyone who smokes knows how horrible it is, and who am i to cast stones? my harping just stresses our relationship (and that is not my desire). my mom is all i have left and i would really like her to be around a few more years! again, jewel, was nice to talk to you in pm-land.

christine

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Christine...I hope this helps

I am a cardiac nurse and this is just some things I learned in the past. I would not recommend carotid massage if your mom had coronary artery disease, or atherosclerosis which she may have due to increased cholesterol. If she has CHF then she needs to quit smoking, eat well (less salt and fat), and usually they prescribe an AHA diet (look on the AHA web page). Most likely MDs prescribe the ABC- an ACE inhibitor, a Beta Blocker, and Calcium channel blocker. (digoxin usually they do not give anymore). Your mom needs a cardiologist. If she is having syncope, or PND then this probably is due to hypotension but also it seems exacerbation of CHF. Make sure that she takes her spiralactone (aldactone) before 6 pm, preferably in the morning or afternoon so she doesn't have to make nightly trips to the bathroom. Your mom needs her medication checked and under control if her BP is too low. I wont let my patient get out of bed if there BP is running that low.

Get your mom a cardiologist right away!! Get your medical insurance to pay for it or call for services that will help with costs. Good luck- take care

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I would highly recommend you take her to a electrophysiology (EP) cardiologist. They are electricians not plumbers like most interventional cardiologists. EP cardiologists are still slightly rare but there should be one fairly near you. They can actually go in with a heart cath and ablate the part of the heart that is causing SVT.

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I would highly recommend you take her to a electrophysiology (EP) cardiologist...EP cardiologists are still slightly rare but there should be one fairly near you.

My initial thoughts exactly. They can do alot in the EP lab like map out her pathways and try to ablate the suspects. They can run her through many pacer modes and find hot spots and initate different drug therapies right at the site to differentiate her problems. If the reason for the SVT isn't correctable, they may drop in a pacer to overdrive her when she pops into SVT.

As for EP cardiology availability...it might be a regional thing. In Florida we have three available for our unit pretty much anythime. You say she had a CABG after stents so you must have an interventional cardiac care unit near you. Those are the same folks that will run her through the EP lab.

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Thanks for the advice. Also, we saw the cardiologist yesterday. He said the type of SVT she has can be cured through ablation. We are set up to see the Dr to schedule the EP studies (and a stress test will be done next week).

thanks again,

Christine

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