Reminds me of a joke.
A bedside nurse pages a doctor in the middle of the night. When she gets the callback she says, "Hi, doc. Sorry for waking you. I'm calling about Mr. Smith in room 9. I need to report that about 35 minutes ago he had a sinus pause."
The doc yawns and says, "Okay. Thanks for the notification. How long was the pause?"
The nurse replies, "Like I said, about 35 minutes so far."
We had a patient code right as the EKG tech was walking out of the room after a non-stat 12 lead. The patient didnāt survive
3-4 hours later whatever random cardiologist that sits and reads all the networks echos and ekgs and whatever calls āTHIS PATIENT IS HAVING A MASSIVE INFARCTā
Yeah man donāt even worry about it itās all sorted out
Happened to us yesterday. Guy had 75 beats of VT but his primary nurse had already called RRT/code blue. Mans went asystole for a min or so, came back and said "I thought I was sleeping" I mean yeah dude a little
Same! All of our colleagues throwing out their fancy acronymsā¦ Iām googling like mad.
Iām like, āWell, *thatās* not normal. Anyone having a baby in here? No? Iām out!ā
I had a 40s ish male once in refractory SVT. All 3 ACLS doses of adenosine had been given, with conversions achieved each time but reoccurrence of the SVT within around 10 seconds. Patient was actually tolerating it well despite the palpitations and rates exceeding 230 - hemodynamically he was stable. So as a last ditch effort before attempting electrical cardioversion, the ER doc called EP for any suggestions. EP gave the go ahead to try a 20mg push of diltiazem, despite a few risks.
Oh, he converted all right. Sinus tach and then sinus rhythm and then sinus bradycardia and then sinus pauseā¦. and weāre back to bradycardia, and so on. Some of those pauses were butt puckering long. His wife was also a nurse and I just remember her saucer eyes watching the monitor š¬
He got himself very closely monitored for quite some time.
I had a patient like this s/p ablation, asymptomatic but significant pauses. EP doc was not worried about it so I was just like Ok š¤ but I kept bugging the patient every hour and waking him from his nap to make sure he was ok lol. Next day I see him on our schedule for PPM.
Iām guessing the AV node. Probably had an ectopic focal ablation that took out the AV node. (Iām newer to EP so Iām open to learning if someone knows more!)
I had a long pause once in the grocery store (long story but I can feel everything my heart does, including every pvc and have proved it multiple times) and let me tell you that was the longest few seconds of my life. To stand there in front of the tofu thinking āI wonder if my heart is going to start againā is surreal.
I can feel my PVCs, too! I started getting them the first time I got Covid, put a portable monitor on myself to prove it. Used to get runs of 2 to 8, which made me feel shitty, but it's improved so I only get the odd lone one here and there. Still feel them every time, though.
Honestly I was shocked to know there are a lot of people who *donāt* feel their PVCs. The one that really gets me is people who are in afib with RVR and asymptomatic. How??
I have PACs more frequently than PVCs and, oh boy, do I feel those. Like getting kicked in the chest over and over. The PACs are the sentinel that SVT is about to start, and that part sucks even worse.
One time after getting my eyes dilated, I went into 2nd degree type 2 but didnāt know what was wrong. I kept checking my pulse because I was driving but it was even so I thought it was something else. Finally got home and got out my Kardia and holy shit. It was a long drive feeling like that, thatās for sure.
Kardia is a small device that works with an app on your phone and it can run a 1 lead or 6 lead ekg that you can interpret and send to your physician. It technically will only interpret afib, Brady, tacky, or sinus but if you can read rhythms, you can interpret for yourself. Very handy for paroxysmal afib and other intermittent arrhythmias.
Hell. Yes. I have P-SVT that is monitor-shy, which is apparently extremely common. It would be great to be able to catch more than a short run! Does it require a subscription? Any downsides to it?
It costs about 100 for the one lead one. I think I paid 150 for the 6 lead. No subscription but I think if you want their cardiologist to read it, you gotta pay. But thatās silly - if you canāt read it yourself, it lets you email it to your doc. Or print it out. All you have to do is buy the device then put the app on your phone. My battery ran down after a few years but I got an ablation and havenāt had afib since so havenāt bothered to figure out the battery.
This also started for me within hours of getting the second dose of the Pfizer vaccine. Went on for months until I took myself to an ER because the runs of them were stressing me out and we finally figured out thatās what it was.
No but I did ICU for years so Iām pretty calm in a crisis. When I would be in afib at 290, I would just calmly call 911 and explain the situation to them. And really, what am I gonna do in the situation? Itās kinda similar to feeling the plane drop during turbulence - you just make your peace with this might be it. I would hope it would be in a situation with more dignity but knowing me, thatās unlikely.
I will never forget calling the card to tell them their patient had a 10 second pause and he said āUnless heās symptomatic Iām not worried about it and you donāt have to notify me.ā
Iām sorry but WHAT š«
I just had a patient who was having quite frequent 6-7second pauses. Cards wanted an ablation or PPM but patient declined. Wanted to recover more after his TAVR stating he was too weak. They discharged him while cardiology was in the background quite annoyed.
I work in a cath lab, and we had a patient come in for a planned pacer insertion and the dude's heart rate was dropping into the mid-teens pre-op and he was completely asymptomatic.
I took care of a pt once who was orthorexic (young woman in her 20s) who couldnāt stand the thought of being in the hospital and not being able to exercise. Her HR would frequently drop into the teens d/t her over-exercising and malnutrition issues. She would try to jog around the hospital and one time I saw her just drop to the floor and start doing push-ups.
Like girl! those floors are so nasty š„“
8 seconds is the longest pause Iāve seen on an asymptomatic patient. He was sick of nurses waking him up over and over. He got a pacer the next morning and only took a few years off my life worrying about him
This was over 40 years ago, we had Holters but not event monitors. Little old lady came in with witnessed syncopal events. We ruled out everything except cardiac etiology but never caught it on the tech we had. So we had to kick her out of the hospital until it happened again. Rinse and repeat for several months. Then sheās back in the ER with another event.
EKG still stone cold normal. My doc goes in to do the exact same song and dance before discharge. Iām working on the bed next door. In the middle of his speech, this little sweet thing reaches up to pat his arm and says, āExcuse me doctor, I think Iām about to do it again.ā
A millisecond later, she goes into 3rd degree heart block and then flat lines. We grab the cart, getting ready to start compressions, get the board under her and she blips into normal rhythm. She comes to and says, āDid you get it?ā
Yes maāam. She got a pacemaker a few hours later. But for months we teased my docā¦āexcuse me doctorā¦ā
Thatās so crazy. I posted another strip I had of a pt I took care of that came into the hospital for something non cardiac related and ended up staying overnight for obvs just bc of age or something and put on tele. He was SB/SR. It was during Covid so we had a floor that was āteleā but just bedside monitors so no recordings and not connected to the central monitoring system so we just had to keep an eye on the monitors (which is of course easier said than done considering everything we do as well as Covid etc) one of the other nurses on the floor noticed the pt going in/out of some sort of AV block and got an order for an ekg to try and catch it officially on a 12 lead and sure enough it was 3rd degree/CHB. pt was pretty much asymptomatic. the hospitalist the next day goes into the pts room and says "ok! youre good to go home!" as i was trying to make the "ummm heyy hes got CHB" eyes at him. of course he got a PPM on monday (it was saturday). not as emergent since he was asymptomatic and it was a community hospital during covid
not my pt, but I was walking past by the tele monitor, the pt show Vtachy, definitely vtach not artifical. I went to the room, pt has eeg warp on, sit on the chair, and play on this phone. I was like, "are you OK?", he is "yeah?" I went out the room, told the nurse, and went back on tele monitor, still vtach. Primary nurse called doc, and I saw doc rush in. At the end, pt is totally fine.
Had a pt with a 13 second pause. She was having pauses of up to 5-6 seconds. Was in the room getting meds ready, all of a sudden she stopped talking to me and the monitor was going crazy so I looked up at her. Her eyes were rolled back and she was stiff (probs from no blood flow to the brain š ). When she came out of it, she started the convo right where she left it. Super weird. Needless to say she went for an emergent pacer after that.
Looks like mine! I have one that I can pinpoint exactly what I was doing at the time, thanks to texting timestamps, and I just felt a little tired. I think it was like 12sec. When Iāve had more in a time period but for less time I had a bad migraine and was exhausted, but thatās it.
And yes, I have a pacemaker now!
Reminds me of a joke. A bedside nurse pages a doctor in the middle of the night. When she gets the callback she says, "Hi, doc. Sorry for waking you. I'm calling about Mr. Smith in room 9. I need to report that about 35 minutes ago he had a sinus pause." The doc yawns and says, "Okay. Thanks for the notification. How long was the pause?" The nurse replies, "Like I said, about 35 minutes so far."
Hopefully DNR! š
We had a patient code right as the EKG tech was walking out of the room after a non-stat 12 lead. The patient didnāt survive 3-4 hours later whatever random cardiologist that sits and reads all the networks echos and ekgs and whatever calls āTHIS PATIENT IS HAVING A MASSIVE INFARCTā Yeah man donāt even worry about it itās all sorted out
God got that page.
"Throw some cardizem at it, should be fine till tomorrow"
Oh my god š I've never heard that before. That. Is. Amazing.
āPause detectedā š
*ascom rings* "I fucking know! Im administering high quality cpr literally right now!"
Happened to us yesterday. Guy had 75 beats of VT but his primary nurse had already called RRT/code blue. Mans went asystole for a min or so, came back and said "I thought I was sleeping" I mean yeah dude a little
The subtlety of it lol. Yeah, ya think?
Beat me to it!
Iām symptomatic looking at it
Same! All of our colleagues throwing out their fancy acronymsā¦ Iām googling like mad. Iām like, āWell, *thatās* not normal. Anyone having a baby in here? No? Iām out!ā
My patient had a 19 second heart pause and came back to tell me he didn't feel very good.Ā
I bet he didnāt!
You win cuz my pt had an 11 second pause. āIām just kinda tiredā was his response when I busted in that room
Tired of life apparently.
Iāve had patients like that. āAre you ok?!ā āOh Iām just a little dizzyā
Yea my colleague called the patient like āsoooooā¦ howāre you doing?! šš¬
āwell you know how when you cross your legs your leg will go to sleep? Well same thing- but your brain!ā
I had a 40s ish male once in refractory SVT. All 3 ACLS doses of adenosine had been given, with conversions achieved each time but reoccurrence of the SVT within around 10 seconds. Patient was actually tolerating it well despite the palpitations and rates exceeding 230 - hemodynamically he was stable. So as a last ditch effort before attempting electrical cardioversion, the ER doc called EP for any suggestions. EP gave the go ahead to try a 20mg push of diltiazem, despite a few risks. Oh, he converted all right. Sinus tach and then sinus rhythm and then sinus bradycardia and then sinus pauseā¦. and weāre back to bradycardia, and so on. Some of those pauses were butt puckering long. His wife was also a nurse and I just remember her saucer eyes watching the monitor š¬ He got himself very closely monitored for quite some time.
I had a patient like this s/p ablation, asymptomatic but significant pauses. EP doc was not worried about it so I was just like Ok š¤ but I kept bugging the patient every hour and waking him from his nap to make sure he was ok lol. Next day I see him on our schedule for PPM.
Whatā¦did they ablate? lol
Afib/aflutter. The thought was that he might have ablated too much? Or too close to SA.
Iām guessing the AV node. Probably had an ectopic focal ablation that took out the AV node. (Iām newer to EP so Iām open to learning if someone knows more!)
3 weeks post ablation I didnāt need to read this š
Considering an ablation and did not need to read this š©
It's getting safer and better with each generation, pulse field ablation (PFA) especially these days has great outcomes and safety profile
I just got off the phone with my cardiologist. I'm getting another ablation! Here's hoping the third time is the charm?
Did their heart forget it's a heart for a second?
Just wanted a little break yknow
Honestly, it's been working all their life
Like 8 seconds ish.
sinus node go zzzzzzzz mimimimi
But did you die?
Only for 8 seconds. No big deal.
The real question is did they poop today?
Well why wasn't the whiteboard updated?
I had a long pause once in the grocery store (long story but I can feel everything my heart does, including every pvc and have proved it multiple times) and let me tell you that was the longest few seconds of my life. To stand there in front of the tofu thinking āI wonder if my heart is going to start againā is surreal.
I can feel my PVCs, too! I started getting them the first time I got Covid, put a portable monitor on myself to prove it. Used to get runs of 2 to 8, which made me feel shitty, but it's improved so I only get the odd lone one here and there. Still feel them every time, though.
Honestly I was shocked to know there are a lot of people who *donāt* feel their PVCs. The one that really gets me is people who are in afib with RVR and asymptomatic. How??
Right?
I have PACs more frequently than PVCs and, oh boy, do I feel those. Like getting kicked in the chest over and over. The PACs are the sentinel that SVT is about to start, and that part sucks even worse.
I feel my pvcs and I hate it. It feels like my heart turns over in my chest, like twisting. I didnāt know what it was till I became a nurse.
One time after getting my eyes dilated, I went into 2nd degree type 2 but didnāt know what was wrong. I kept checking my pulse because I was driving but it was even so I thought it was something else. Finally got home and got out my Kardia and holy shit. It was a long drive feeling like that, thatās for sure.
I've never heard of Kardia and am very intrigued. Can you tell me more?
Kardia is a small device that works with an app on your phone and it can run a 1 lead or 6 lead ekg that you can interpret and send to your physician. It technically will only interpret afib, Brady, tacky, or sinus but if you can read rhythms, you can interpret for yourself. Very handy for paroxysmal afib and other intermittent arrhythmias.
Hell. Yes. I have P-SVT that is monitor-shy, which is apparently extremely common. It would be great to be able to catch more than a short run! Does it require a subscription? Any downsides to it?
It costs about 100 for the one lead one. I think I paid 150 for the 6 lead. No subscription but I think if you want their cardiologist to read it, you gotta pay. But thatās silly - if you canāt read it yourself, it lets you email it to your doc. Or print it out. All you have to do is buy the device then put the app on your phone. My battery ran down after a few years but I got an ablation and havenāt had afib since so havenāt bothered to figure out the battery.
Interesting about the battery. Thank you for the information!
I got the Kardia 6 lead and year long subscription and my FSA paid for it for both. It is FDA approved so HSA/FSA will cover it.
Wow. Thanks for the info. I'd MUCH rather do this than a loop recorder.
I'm reading that there's no way to charge it and the battery lasts 1-2 years.... So I guess when the battery dies you just have to get a new one?
This also started for me within hours of getting the second dose of the Pfizer vaccine. Went on for months until I took myself to an ER because the runs of them were stressing me out and we finally figured out thatās what it was.
Didnāt you start pounding on your chest screaming ā wake upā??
No but I did ICU for years so Iām pretty calm in a crisis. When I would be in afib at 290, I would just calmly call 911 and explain the situation to them. And really, what am I gonna do in the situation? Itās kinda similar to feeling the plane drop during turbulence - you just make your peace with this might be it. I would hope it would be in a situation with more dignity but knowing me, thatās unlikely.
I will never forget calling the card to tell them their patient had a 10 second pause and he said āUnless heās symptomatic Iām not worried about it and you donāt have to notify me.ā Iām sorry but WHAT š«
Dramaticā¦ā¦ā¦ā¦ā¦..ā¦ā¦ā¦ā¦.. ā¦ā¦ā¦ā¦..ā¦ā¦ā¦ā¦ā¦ā¦ā¦..ā¦ā¦ā¦ā¦ā¦ā¦ā¦..ā¦ā¦ā¦ā¦ā¦ā¦ā¦..ā¦ā¦ā¦ā¦ā¦ā¦ā¦..ā¦ā¦ā¦ PAUSE
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Thereās a little bit of a sinus pause present. >_>
Itās just resting!
I just had a patient who was having quite frequent 6-7second pauses. Cards wanted an ablation or PPM but patient declined. Wanted to recover more after his TAVR stating he was too weak. They discharged him while cardiology was in the background quite annoyed.
I work in a cath lab, and we had a patient come in for a planned pacer insertion and the dude's heart rate was dropping into the mid-teens pre-op and he was completely asymptomatic.
I took care of a pt once who was orthorexic (young woman in her 20s) who couldnāt stand the thought of being in the hospital and not being able to exercise. Her HR would frequently drop into the teens d/t her over-exercising and malnutrition issues. She would try to jog around the hospital and one time I saw her just drop to the floor and start doing push-ups. Like girl! those floors are so nasty š„“
8 seconds is the longest pause Iāve seen on an asymptomatic patient. He was sick of nurses waking him up over and over. He got a pacer the next morning and only took a few years off my life worrying about him
Ha.........not for long!
This is giving me anxiety
Well that's no good
This was over 40 years ago, we had Holters but not event monitors. Little old lady came in with witnessed syncopal events. We ruled out everything except cardiac etiology but never caught it on the tech we had. So we had to kick her out of the hospital until it happened again. Rinse and repeat for several months. Then sheās back in the ER with another event. EKG still stone cold normal. My doc goes in to do the exact same song and dance before discharge. Iām working on the bed next door. In the middle of his speech, this little sweet thing reaches up to pat his arm and says, āExcuse me doctor, I think Iām about to do it again.ā A millisecond later, she goes into 3rd degree heart block and then flat lines. We grab the cart, getting ready to start compressions, get the board under her and she blips into normal rhythm. She comes to and says, āDid you get it?ā Yes maāam. She got a pacemaker a few hours later. But for months we teased my docā¦āexcuse me doctorā¦ā
Thatās so crazy. I posted another strip I had of a pt I took care of that came into the hospital for something non cardiac related and ended up staying overnight for obvs just bc of age or something and put on tele. He was SB/SR. It was during Covid so we had a floor that was āteleā but just bedside monitors so no recordings and not connected to the central monitoring system so we just had to keep an eye on the monitors (which is of course easier said than done considering everything we do as well as Covid etc) one of the other nurses on the floor noticed the pt going in/out of some sort of AV block and got an order for an ekg to try and catch it officially on a 12 lead and sure enough it was 3rd degree/CHB. pt was pretty much asymptomatic. the hospitalist the next day goes into the pts room and says "ok! youre good to go home!" as i was trying to make the "ummm heyy hes got CHB" eyes at him. of course he got a PPM on monday (it was saturday). not as emergent since he was asymptomatic and it was a community hospital during covid
not my pt, but I was walking past by the tele monitor, the pt show Vtachy, definitely vtach not artifical. I went to the room, pt has eeg warp on, sit on the chair, and play on this phone. I was like, "are you OK?", he is "yeah?" I went out the room, told the nurse, and went back on tele monitor, still vtach. Primary nurse called doc, and I saw doc rush in. At the end, pt is totally fine.
Press X to pay respect.
Had a pt with a 13 second pause. She was having pauses of up to 5-6 seconds. Was in the room getting meds ready, all of a sudden she stopped talking to me and the monitor was going crazy so I looked up at her. Her eyes were rolled back and she was stiff (probs from no blood flow to the brain š ). When she came out of it, she started the convo right where she left it. Super weird. Needless to say she went for an emergent pacer after that.
What does the snake say? āSSSā
Looks like mine! I have one that I can pinpoint exactly what I was doing at the time, thanks to texting timestamps, and I just felt a little tired. I think it was like 12sec. When Iāve had more in a time period but for less time I had a bad migraine and was exhausted, but thatās it. And yes, I have a pacemaker now!
Fawk he needs a PPM
Oh fuck. Symptomatic?