Extremely rapid heartrate question. YANMD etc.
October 22, 2015 11:29 AM Subscribe
My elderly mother apparently has atrial fibrillation and other problems. She recently did a EKG and her doctor said it came back with 500bpm. I looked that up and the interwebs said that's basically impossible, you'd be dead.
Anyone have any info? Some of her other recommendations are basically based on this (although there could be some 'elderly moments' at play here. Just trying to get some fact-based medical advice here. Anyone?
Given that a heartrate of 500bpm isn't physically possible, I think the first step is going to be getting accurate information from her doctor. If you live close to her, I'd see if she will let you accompany her to her next appointment. If you can't go with her, I'd try to get her permission to speak with her doctor - the doctor's office may have a form she can fill out.
posted by insectosaurus at 11:45 AM on October 22, 2015 [3 favorites]
posted by insectosaurus at 11:45 AM on October 22, 2015 [3 favorites]
My mom had SVT's, racing heart. She had an ablation, that worked.
My step mom took her diabetic med and exercised before breakfast, then developed A-fib. So make sure she has a good heart doc, outside the practice of her current one to make sure the diagnoses are correct.
My grandmother in law was in a hospital with a "dry" heartbeat for days, before anyone figured out a great blood clot was blocking the entrance to her heart. They figured this out after it killed her. So, if you get confusing results and some present as potentially lethal, and nothing is done...get a second opinion. Don"t dawdle. If by elderly you mean 99 years old then stay close to her, keep her company.
posted by Oyéah at 11:53 AM on October 22, 2015
My step mom took her diabetic med and exercised before breakfast, then developed A-fib. So make sure she has a good heart doc, outside the practice of her current one to make sure the diagnoses are correct.
My grandmother in law was in a hospital with a "dry" heartbeat for days, before anyone figured out a great blood clot was blocking the entrance to her heart. They figured this out after it killed her. So, if you get confusing results and some present as potentially lethal, and nothing is done...get a second opinion. Don"t dawdle. If by elderly you mean 99 years old then stay close to her, keep her company.
posted by Oyéah at 11:53 AM on October 22, 2015
I'm not a medical doctor, and you should definitely follow up with your mother's cardiologist. But I'm guessing the 500bpm is her atrial rate, and that the rate if her ventricles is much lower. Often, only 1/2 or 1/4 of the atrial beats will "conduct" down to the ventricles (they might have referred to this as "four to one conduction"or something similar). This type of arrhythmia might be called atrial flutter, a type of supraventricular tachycardia. The ventricles need time to fully fill with blood between each beat, or else they won't be able to pump enough blood through the body. You're right that a ventricular rate of 500bpm shouldn't be possible - you'd end up without a pulse. A fast atrial rate is not as acutely dangerous as a ventricular tachycardia, but will still lead to clotting complications, and hopefully she can get it managed with her doctor.
posted by twoporedomain at 11:57 AM on October 22, 2015 [4 favorites]
posted by twoporedomain at 11:57 AM on October 22, 2015 [4 favorites]
Cardiac ICU nurse, but not your cardiac ICU nurse.
It’s possible that the atria are firing at an 6:1 or 8:1 rate, but a 12-lead EKG won’t show that. No cardiologist worth his/her salt would say that a patient with a radial pulse of 72 and an atrial flutter rate with 6:1 conduction has a heart rate of 430 bpm.
It’s entirely possible that your mom saw the machine interpretation at the top of the EKG, and it might have said something like that, which is why we never ever ever ever trust what the machine says in its little blurb. The machine is wrong in its algorithm as often as not. We get our calipers out and do our own measurements and our own counting and our own brains. (Unless we’re a family practice doctor with little to no cardiology experience, in which case we send people to the ER for heart attacks they aren’t having and other interesting figments of the imagination. Guess how I know that?)
Having just dissed the EKG machine’s little machine brain, it would not say something like that about someone in a-fib - it would say ‘atrial fibrillation’ (or possibly atrial flutter, though that’s a very clear pattern) and count the ventricular rate.
SVT can absolutely be as serious as v-tach, though it doesn’t usually result in death within minutes. It can cause loss of consciousness just as quickly as v-tach can because blood doesn’t get to the brain - there’s no time to refill the chambers completely with blood between contractions, so less blood gets to the brain, so syncope (fainting). This happens more with SVT that’s sudden in onset than with someone who’s had a-fib for a while.
Bottom line: find a cardiologist and get your mom diagnosed correctly.
posted by lambchop1 at 1:34 PM on October 22, 2015 [10 favorites]
It’s possible that the atria are firing at an 6:1 or 8:1 rate, but a 12-lead EKG won’t show that. No cardiologist worth his/her salt would say that a patient with a radial pulse of 72 and an atrial flutter rate with 6:1 conduction has a heart rate of 430 bpm.
It’s entirely possible that your mom saw the machine interpretation at the top of the EKG, and it might have said something like that, which is why we never ever ever ever trust what the machine says in its little blurb. The machine is wrong in its algorithm as often as not. We get our calipers out and do our own measurements and our own counting and our own brains. (Unless we’re a family practice doctor with little to no cardiology experience, in which case we send people to the ER for heart attacks they aren’t having and other interesting figments of the imagination. Guess how I know that?)
Having just dissed the EKG machine’s little machine brain, it would not say something like that about someone in a-fib - it would say ‘atrial fibrillation’ (or possibly atrial flutter, though that’s a very clear pattern) and count the ventricular rate.
SVT can absolutely be as serious as v-tach, though it doesn’t usually result in death within minutes. It can cause loss of consciousness just as quickly as v-tach can because blood doesn’t get to the brain - there’s no time to refill the chambers completely with blood between contractions, so less blood gets to the brain, so syncope (fainting). This happens more with SVT that’s sudden in onset than with someone who’s had a-fib for a while.
Bottom line: find a cardiologist and get your mom diagnosed correctly.
posted by lambchop1 at 1:34 PM on October 22, 2015 [10 favorites]
Yeah, 500 beats per minute isn't humanly possible. You need to get some clear info from the doctor: What did the EKG show? What is causing the problem? What does she need to do to treat it? If her EKG was very abnormal, I would think they'd have her wear a 24-hour Holter monitor to understand what her heart is doing a bit better. If your doctor didn't do that or recommend some course of treatment after that EKG, I would make her see a new doctor. If you are getting second-hand info from your elderly mother, it sounds like it's getting misconstrued. Can you go to the doctor with her to ensure she is following doctor's instructions?
posted by AppleTurnover at 3:25 PM on October 22, 2015
posted by AppleTurnover at 3:25 PM on October 22, 2015
But I'm guessing the 500bpm is her atrial rate, and that the rate if her ventricles is much lower.
twoporedomain is correct. I am not a doctor. My sweetie also has atrial fibrillation, when fibrillating his rate can hover in the 500's - this is the atrial rate and not the entire heart or the ventricle rate.
If your mother is amenable I'd suggest speaking with her doctor. The more people she has who understand the condition and know when/how to intervene when necessary the better.
posted by space_cookie at 7:57 PM on October 22, 2015
twoporedomain is correct. I am not a doctor. My sweetie also has atrial fibrillation, when fibrillating his rate can hover in the 500's - this is the atrial rate and not the entire heart or the ventricle rate.
If your mother is amenable I'd suggest speaking with her doctor. The more people she has who understand the condition and know when/how to intervene when necessary the better.
posted by space_cookie at 7:57 PM on October 22, 2015
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posted by HuronBob at 11:43 AM on October 22, 2015 [7 favorites]