Dispatched for yet another sort of vague chest pain complaint. The patient was an 80 something year old lady who awoke with chest pain unlike anything she’s had before. She looked uncomfortable, but seemed to be perfusing well. BP was 280/90, HR was, uh, fast. I figured it around 150 or so because when it gets up that fast it gets hard for me to count. Respiratory rate was 28, which is a bit worrisome for a lady of that age range. Her Oxygen saturation was a totally unhelpful to our diagnosis 100%.
We applied the monitor and found a SVT at about 160, which we decided might well be Atrial Tachycardia. Might not be, though, so we took the safe route of administering Diltiazem. My partner worked on starting the IV while I worked on mixing up the drug. We get ours as a powder that we mix with liquid and then inject slooooooowly into the patient.
Well, that was the plan, but the patient’s veins weren’t cooperating. She had pointed out the “best” vein to my partner, but his attempt to get a tiny 22 gauge IV in didn’t work. We decided it was time to move to the ambulance where the lighting was (much) better and try again.
Which is the point at which the patient’s cardiac conduction system took matters into it’s own hands and did this,
And of course this happened during the one nanosecond we were not looking at the monitor or the patient. Why the rhythm broke is as much as mystery as to why it started in the first place. Nothing in her history or medication list suggested this sort of thing. The best thing about it was that as soon as her rhythm broke and heart rate dropped back to normal, her chest pain went away completely. I can’t take a bit of credit for that, not one bit at all.
We took the nice lady to the hospital where I relayed the story to the medical staff. I also suggested that maybe it was a case of alien abduction, where they beam up our patient and beam down an exact duplicate that has a different cardiac rhythm. They weren’t buying it, but I think it’s as rational explanation as anything else.