83 yo female, s/p angioplasty 4 days ago, w/ stents. No complications reported. Discharged home after 23 hr obs. Just transported to hospital with significant nausea, HR: 46. O2 sats: 92 on RA, BP: 132/78, responsive , denies abdominal pain, chest pain or Headaches. With this brady rate, and not seeing the monitor, not sure if in A-Fib/ Flutter or not. comorbids: type II diabetic , insulin dependent... BS unknown at present s/p CABG 20 yrs ago, with multiple caths and angioplasties since. + CVA , with freq. TIA s. Hypertension. Deconditioned. I am thinking several things for treatment: pacemaker, if a candidate. But again, not sure what is interfering with the heart s electrical system. Plus, not having a full knowledge of meds on board is also a minus. Your thoughts?
Hiwith so many complications at that age is really a pitiable state. Post angioplasty, post CABG, recurrent TIA & Diabetic, now with bradycardia & nausea looks like patient has been suffering from complete heart block. She is an ideal candidate for pacemaker. If the ECG shows arrhythmias & her left ventricular ejection fraction is low, pacemaker with ICD(intro cardiac defibrillator), is the treatment of choice. Pacemaker does not destroy the electrical system, but rather supports for improved functioning. All the best, take care