- Joined
- Oct 9, 2010
- Messages
- 191
- Reaction score
- 109
So here is the situation:
There is a patient with severe panic disorder and diagnosed OCD by psych. He is a compulsive pulse checker. Arrives at an acute care center off-campus with a HR stable at around 120-130 with fever and signs of dehydration. Given 3000ml NS over a period of 3-4 hours in acute care center along with 1g tylenol & 1mg ativan. Patient was very anxious during his whole stay in acute care ctr and was transferred to the ER on the main campus.
Because of his heart rate concerns (kept asking the doctor I was with as well as the nurse if his HR was in a 'dangerous' zone despite being an otherwise healthy 25y/o normal EKG & recent stress echo), they hit him with 50mg of Lopressor IV although the cardiologist oncall said this was not necessary, he ok'd it given the patients high anxiety at his rapid heart rate. Also administered another milligram of ativan.
His later diagnosis was viral gastroenteritis, probably from bad sour cream he ingested the night earlier.
But anyway, my question is about the Lopressor and this may seem to be a very, very silly question. Now one of the reasons why patients develop tachycardia with many infections is because the microorganism is emitting vasoactive substances, so in order to compensate the heart obviously must increase rate to maintain adequate blood pressure.
The dummy question I have is this: If the patients heart rate is elevated in order to maintain adequate pressure/CO, wouldn't giving him a beta blocker only work to exacerbate the problem? You will have to forgive me as I am only a first year med student. I asked the ID doctor and the cardiologist and they said it shouldn't be an issue.
To me if the heart is compensating by increasing HR, it seems dangerous to lower BP further to get rate control. This question probably is quite ridiculous but thanks anyway for your patience.
There is a patient with severe panic disorder and diagnosed OCD by psych. He is a compulsive pulse checker. Arrives at an acute care center off-campus with a HR stable at around 120-130 with fever and signs of dehydration. Given 3000ml NS over a period of 3-4 hours in acute care center along with 1g tylenol & 1mg ativan. Patient was very anxious during his whole stay in acute care ctr and was transferred to the ER on the main campus.
Because of his heart rate concerns (kept asking the doctor I was with as well as the nurse if his HR was in a 'dangerous' zone despite being an otherwise healthy 25y/o normal EKG & recent stress echo), they hit him with 50mg of Lopressor IV although the cardiologist oncall said this was not necessary, he ok'd it given the patients high anxiety at his rapid heart rate. Also administered another milligram of ativan.
His later diagnosis was viral gastroenteritis, probably from bad sour cream he ingested the night earlier.
But anyway, my question is about the Lopressor and this may seem to be a very, very silly question. Now one of the reasons why patients develop tachycardia with many infections is because the microorganism is emitting vasoactive substances, so in order to compensate the heart obviously must increase rate to maintain adequate blood pressure.
The dummy question I have is this: If the patients heart rate is elevated in order to maintain adequate pressure/CO, wouldn't giving him a beta blocker only work to exacerbate the problem? You will have to forgive me as I am only a first year med student. I asked the ID doctor and the cardiologist and they said it shouldn't be an issue.
To me if the heart is compensating by increasing HR, it seems dangerous to lower BP further to get rate control. This question probably is quite ridiculous but thanks anyway for your patience.
