rapid a fib with high blood pressure?

KBICU · Sep 8, 2012

It could be for many reasons. Was it a manual bp? Did they take their beta blocker today? Ive had many pts who go into a fib with RVR because they havent been taking their meds. It simply could be the heart is under stress. Do they have kidney issues? Unexplainds htn could be caused by adrenal tumors or disease. In those situations we usually start a cardizem gtt or try IV lopressor. What ended up happening?

LetsChill · Sep 8, 2012

Hello,
New nurse almost off orientation on telemetry. Pt. was direct admit from MD, walked onto the floor and into my room with no information to moi. When put on monitor hr a fib 160's- 180's, apical the same (if I could really count three irregular beats a second). BP during this time 160/100, pt. reports self to be asymptomatic. I did not really worry about a pulse defecit to see how many beats were perfusing peripherally as I was more worried about rate control at the time. Question: Why is BP so high when heart should not be having time to fill and pump? Thanks for attempts at answering with little information.

Pt walked onto your floor with that HR? Not on a stretcher? Wow. Lucky he didn't collapse with that HR and then fall and bleed (just guessing this is a history of a fib and he's on Coumadin or something similar).

Anyway, exercise is going to make his BP higher than at rest, even with a fib. I always document the admit BP after pt has been resting awhile.

Walking stimulates the sympathetic nervous system, and in pts with a cardiac history (which I am assuming he has) it doesn't take much exercise to increase BP and HR. I'd say both are elevated in this case r/t his activity.

Guy needs a gtt and rest.

valsalvamanuever2 · Sep 9, 2012

Pt was told to come to hospital after observed bp/hr at pcp's office. Yeah I have not been oriented/asked out loud how/why exactly some pt.s of this type are allowed to come over unsupervised if they warrant inpatient status.

1. In an old copy of "the ICU book" that I picked up it says that hypotension due to loss of atrial kick occurs above heart rates of 180. How empirically studied this is I do not know. I would have to assume this is in healthy hearts as I have seen old tired hearts hypotensive at fast rates that are south of 180. But, these pt.s often have the typical comorbidities.

2. BP was double checked manual at rest. I do like the idea that kidney malfunction and the RAAS system could have some input on pressures that lack of filling/pumping time of the heart at that rate may not have. I did not think of that.

3. This pt. was about to receive a cardizem bolus followed by gtt when she converted on her own to NSR in the 70s. At that point she told us that this was the third or so time that this has happened. (Thanks for the info ) She's asymptomatic when she does this.

4. D/cd an hour later. F/u with cardiologist. I would think an EP study should be in their future? I would have been hesitant to go out the door...

LetsChill · Sep 9, 2012

4. D/cd an hour later. F/u with cardiologist. I would think an EP study should be in their future? I would have been hesitant to go out the door...

An hour later was discharged? We'd keep him on a gtt and put him on PO before taking him off the gtt then home eventually on PO. Did he go home on cardizem or metoprolol PO?

turnforthenurse, MSN, NP · Sep 9, 2012

An hour later was discharged? We'd keep him on a gtt and put him on PO before taking him off the gtt then home eventually on PO. Did he go home on cardizem or metoprolol PO?

Exactly what I was going to say/ask... :eek:

KBICU · Sep 9, 2012

I agree with above we usually keep on gtt then go the PO route although i did have a patient started on fleccanide the other night. Im also surprised they got dcd after an hour....yikes

valsalvamanuever2 · Sep 9, 2012

Pt. converted spontaneously. Bolus and GTT were about to be started when she went SR 60's/70's. The cardiologist who follows her as an inpatient felt that she could be seen outpatient for f/u. Typically when we convert people via drips we do the drip to po route for maintenance as others pointed out. The doc following her felt drip unnecessary and felt comfortable following her in the office. With the obvious next question of: But what if she does it again with different outcomes?

KBICU · Sep 10, 2012

Pt. converted spontaneously. Bolus and GTT were about to be started when she went SR 60's/70's. The cardiologist who follows her as an inpatient felt that she could be seen outpatient for f/u. Typically when we convert people via drips we do the drip to po route for maintenance as others pointed out. The doc following her felt drip unnecessary and felt comfortable following her in the office. With the obvious next question of: But what if she does it again with different outcomes?

Hopefully she has had the teaching by the mds or rns of what signs and symptoms to look out for (dizziness, palpitations, etc) and was told to come back to the er if she experiences anything. What outcomes do you mean exactly?

valsalvamanuever2 · Sep 11, 2012

Hopefully she has had the teaching by the mds or rns of what signs and symptoms to look out for (dizziness, palpitations, etc) and was told to come back to the er if she experiences anything. What outcomes do you mean exactly?

I meant if her heart did this again and was either symptomatic (i.e. dizzy and takes an unplanned meeting with the ground) or asymptomatic (until her heart can't do this anymore and takes an unplanned break).

Thanks everyone for the responses as I start to see actual clinical presentations of the things I have read about. Normally after the ride home I come up with questions about the bigger picture that I don't put together while I am running around trying to complete my tasks. I did not discharge her myself as it was change of shift soon after she converted.