41 year old female chest tightness and palpatations hyperte | Figure 1

kjames618

Paramedic

41 year old female chest tightness and palpitations

Related Cases

48-year-old male presents with palpitations, chest pain, abdominal pain, as well as nausea and vomiting. Patient reports the symptoms started this morning and he wanted to see if they would just go away, they did not, prompting him to call EMS around 11:30 PM. Initial EKG reveals atrial fibrillation w/RVR. Initial BP SYS 190s, DIA 110s. Patient has history of myocardial infarction, hypertension, and atrial fibrillation. Patient takes amiodarone, Cardizem, and metoprolol. Once patient inside the EMS unit, note the patient’s heart rate to have increased to 230s-260s. Unable to palpate radial pulse, cardiac monitor, unable to obtain BP. Defib pants placed on patient in anticipation for cardioversion. Patient spontaneously converts back to atrial fabulation w/RVR and once again profoundly hypertensive. Did not note a delta wave, PT has no HX of WPW. 20mg Cardizem bolus followed by 5mg/hr infusion keeps his rate around 110. Patient still complaining of 10/10 chest pain. Patient remains profoundly hypertensive. Patient given ASA, 2X SL Nitro, Nitro paste, 10mg Morphine (total), 8mg Zofran. Nitro and Morphine do little to ease the patient's pain or help normalize his BP. Did patient have an episode of AVNRT OR AVRT that caused HR to spike above 230?

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