EP Lab Digest - January 2008 - (Page 31) JANUARY 2008 EP 101 31 becomes symptomatic? Responses vary: a) A cardioinhibitory response: The pulse will drop and the pacemaker will kick in. b) A vasodepressor response: The patient will experience hypotension without pacing. c) A mixed response:The patient will experience a combination of both a & b: low blood pressure with a change to bradycardia, meaning that there will be pacing. A tilt table test can make many patients feel nervous.That is why patient education pre- and post-test will help make their experience more pleasant, regardless of the results. Acknowledgements: This article was written under the guidance of Christian Machado, MD, and the EP staff at Providence Heart Institute: Jack Cain, Manager, John Owings, RN, Jessica Ottino, RN, and Kathy Bell, CVT. Readers, please contact us if there are specific topics you would like to see covered in EP Lab Digest’s “EP 101” section. In next month’s issue, we will be including another installment of the ECG 101 section. Have you had any unusual results from a test? There have been many unique cases here at Providence. We do have our straightforward and uneventful tests, but there have also been many interesting tilts. In one case, a patient went into asystole for almost 10 seconds; we moved the patient back into the Trendelenburg position, and the patient woke up unaware of what had just happened. In addition, we have had patients pass out right at the 30minute mark, moments before the test is completed. There are also always incidents where a patient complains of symptoms and intolerance to being tilted. This is followed by verbalizing fear, “anxiety” or “headaches” with absolutely no significant changes in the patient’s vital signs. In these circumstances, the physician may speak to the referring doctor and order alternative evaluations. A patient should only be tilted as long as they feel they can maintain themselves in this compromising position. Regardless of the evidence (or lack of), we must give them the benefit of doubt and tilt them back down so they can begin to recover at will. Introducing the What do I tell the patient after the test is completed? Once the patient’s symptoms have alleviated, bring them back to the supine position and get some readings of their pressures and heart rate. As soon as it can be confirmed that they are stable, let them sit up. If there are no other scheduled tests following the tilt evaluation, give the patient some water, maybe even some crackers. They should have been NPO for hours before the test, so hydration may help and they’ll appreciate it. Have a physician speak to the patient. It is at this time that the results can be studied and analyzed, and the physician can make his decisions for treatment if the test is positive, or recommend other exams if the test is negative. D i s c o v e r Yo u r S i x t h S e n s e The confidence, control, and accuracy you always dreamed of—that’s the power of the Sensei™ Robotic Catheter System, with IntelliSense™ Fine Force Technology. Superb catheter control in three dimensions, with six degrees of freedom and immediate force-sensing quantification, takes you beyond the limitations of the past—all while seated away from the field of radiation. Discover your next power at www.hansenmedical.com. The safety and effectiveness of this system for use with cardiac ablation catheters in the treatment of cardiac arrhythmias, including atrial fibrillation, have not been established. 380 North Bernardo Avenue | Mountain View, CA 94043 | PH: 650 404 5800 | FAX: 650 404 5901 | www.hansenmedical.com © 2007 Hansen Medical, Inc. All rights reserved. 112807 http://www.hansenmedical.com http://www.hansenmedical.com http://www.hansenmedical.com
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