Thursday, December 12, 2002|
Paul is 61 and scared. His chest feels like someone is sitting on it, he's sick to his stomach, dizzy and can't seem to get enough air. It's 3 a.m. and he knows this is not a good way to wake up. His symptoms are typical, as is his response: "I just thought it would go away." As is frequently the case, his wife made him come in. The impulse for the heartbeat originates in the heart, itself. Beginning at a place inside the right upper chamber, an electrical impulse is generated that, in turn, generates wave upon wave of similar impulses spreading down and out like ripples in a three-dimensional pond. There are standard pathways that cause the upper, smaller chambers of the heart to contract, and then the larger, more powerful lower chambers. For most of us, this happens 60 to 100 times a minute, night and day, awake and asleep, until the day it stops for good. Paul tries to tough it out, to act casual as though "I do this all the time - no big thing.": But his thin smile is less than convincing and his heart, oh by the way, is beating a cool 160 times a minute. At that rate, the ventricles don't have time to fill before they are squeezed again. Output drops, the blood supply to the heart, lungs and brain becomes less than sufficient and panic ensues. Now here's the part that's too cool for school: this is a problem that is easy to fix. Paul gets a quick EKG (heart tracing) to confirm the rhythm, a quick IV and then a very quick bolus of adenosine. Adenosine is a medication that stops the heart and allows its natural pacemaker to reset itself. The medicine is fast acting and doesn't last long - three seconds or less of inactivity is all it takes. When you're the patient, or watching the monitor for the first time, three seconds seems like a lot. Imagine: lub-dub (one- mississippi, two mississippi, three mississippi), lub-dub. Watching the monitor flatline for even that short period of time can be, well, heart-stopping. Then the drug wears off (it always does), the regular beats resume and you've got a patient who looks better and feels better. The blood pressure is back to normal, the chest pain is gone - smiles all around. Paul got transferred to intensive care, to make sure the fast rhythm doesn't restart and to test for any signs of heart attack. This time the smile was genuine as he left the ED.
It's nice when a plan comes together. |
Last update: 7/12/04; 13:17:13 .
