ChrisPAinED Posted April 27, 2022 Share Posted April 27, 2022 I had this patient come in to the ED with palpations, lightheadedness, nausea, and generalized weakness. Patient had a heart rate in 140s and staying there. BP was slightly elevated as expected. O2 was 97% on RA. RR 10, temp was 98.7f, BGL was 109. ECG was sinus tachycardia otherwise normal. Heart sounded loud and fast and lungs were clear. CBC, BMP, UA, D-dimer, troponin, and CRP we're for the most part normal. The troponin was 0.04 which norm is 0.00-0.04 so we decided to repeat this in 4 hours. With a deep dive into history she has a history of high heart rates but typically in low 100s. No other past medical history. So this left me confused. We treated nausea and was just going to let the patient rest to see if there was some anxiety. But after about 3 hours I checked back in and the heart rate was 145 so I asked the ER doc what to do and he said to call and ask OnCall cardio. So I did and they wanted a more recent troponin so we waited and it came back 0.03 so just meaning it isn't going up at a significant rate. Cardiology said to admit patient for farther monitoring because weakness was still present and that is a fast tachycardia. I know that they dropped the heart rate on the floor and discharged after a day on a inpatient holter and they were going to follow up with cardiology. I don't know any other inpatient detail but anyone have a clue what caused the tachycardia and symptoms? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 28, 2022 Moderator Share Posted April 28, 2022 In my neck of the woods that would be someone on meth who should know better. 2 Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted April 28, 2022 Author Share Posted April 28, 2022 Just now, EMEDPA said: In my neck of the woods that would be someone on meth who should know better. Tox was neg. My mistake didn't mention it but we always order a urine tox with or Urine analysis. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 28, 2022 Moderator Share Posted April 28, 2022 Was TSH done? 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted April 28, 2022 Share Posted April 28, 2022 Other things - you may have already covered these: Pt's pupil size & reactivity - possible sign of sympathetic stimulation: anxiety, stress, ingestions Consumption of caffeine: energy drinks, tea/coffee Dehydration? Was pt fluid responsive? 1 Quote Link to comment Share on other sites More sharing options...
Overtired Posted April 28, 2022 Share Posted April 28, 2022 As noted rate stays 140. Wo seeing ekg would suspect 2:1 flutter w incorrect machine interpretation. Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted April 28, 2022 Author Share Posted April 28, 2022 15 hours ago, EMEDPA said: Was TSH done? Internal medicine service did order a TSH which was normal Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted April 28, 2022 Author Share Posted April 28, 2022 9 hours ago, ohiovolffemtp said: Other things - you may have already covered these: Pt's pupil size & reactivity - possible sign of sympathetic stimulation: anxiety, stress, ingestions Consumption of caffeine: energy drinks, tea/coffee Dehydration? Was pt fluid responsive? Pupils were pinpoint, I did let them sit for a few hours in interrupted so I would assume the HR would dropped some if anxiety, maybe stress was somewhat associated with a increase in heart rate, no consumption of caffeine when I asked, patient had no changes with some fluids. Also some other type of issue occurred that was caught by holter but not our ECG so maybe a arrhythmia that gets the heart rate up and for some reason it takes a long time for it to drop after. Just a guess I know the holter showed something that they were able to temporarily suppress Quote Link to comment Share on other sites More sharing options...
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