please help if you would......

[bebop1]

Hi....I work in a LTC unit, and have a pt with a pacemaker. she has afib, and she is "going all over the place". at one moment her heart rate will be 40, but most of the time her heart rate is in the 110-130's.

the md states the pacer will not kick in unless the heart rate is less than 50. I thought ( please tell me if I am wrong) there are pacers that will "make the heart increase and decrease" if you will. I asked the doctor and he said no.

but he wants a pacemaker check anyways by phone.

can anyone help a little LTC nurse here? or what do I need to look at or assess? please help me..... Pt does c/o of sob when the hr gets high, but after rest it goes down???what do I need to look at? I have contacted her cardio md and have gotten an appt for her over the "house doctors" head. because I think something is going on. I told the house md...he said..."whatever"

any suggestions?

[dianah, ASN]

If the pacer's lower rate is set at 50, it should 'kick in' if the patient's own rate falls below 50. In otherwords, the patient should not have a heart rate of 40 IF the pacer is working as it should.

Is the patient's appointment with her Cardiologist who runs a pacemaker clinic? At a pacemaker clinic appointment, trained staff (or a representative from the company who made the unit implanted in the pt) will interrogate the pacemaker (not just over the phone), check its settings and battery life and determine if it is working properly or needs reprogramming or ? ?

Many times atrial fib produces RVR = rapid ventricular response, which produces SOB and hemodynamic instability. Treatment is beta blockers to slow heart rate, however sometimes heart rate is slowed too much. Pacemaker is then implanted to keep heart rate from dropping too low, so higher doses of beta blockers can be used to keep heart rate down. Pacemaker gives added margin of safety for medication dosage.

Good thing you got pt an appt! Follow your gut.

Here's one site I found when I did a google search for "pacemaker atrial fibrillation:"

http://health.yahoo.com/heart-treatment/pacemaker-for-atrial-fibrillation/healthwise--hw159813.html

You might try other words for the search. Good luck! :)