Wireless moonlight: An ultra-short case study

L. Indumathi

Nurse Educator, Kauvery Hospital, Salem, India

*Correspondence: Tel: +91 96260 55335; email: indumaya1986@gmail.com

Wireless moonlight: An ultra-short case study

Case Presentation

A 70 years old gentleman who had chest pain on 26-06-2022 was taken to outside hospital for treatment and he was referred to Kauvery hospital, Salem for further management.

He presented to emergency department on 01.07.2022 at 4.18 pm with the history of chest pain and palpitation for the past 1 month but aggravated from afternoon. There was no history of dyspnea, cough or pain radiating to neck.

Patient was a known case of Parkinsonism for past 18 years and on regular drugs for the same. He was not known to have comorbidities like Hypertension/Diabetes Mellitus.

Vital signs on admission

Heart rate: 22 beats/min; Respiration: 20 breath/min; blood pressure: 100/60 mmhg; Spo2 – 97%; Weight- 60 kg; CBG -175 mg/dl

ECG findings: Severe bradycardia due to absence of Atrial Ventricular conduction, Atrial Ventricular dissociation with independent Atrial and ventricular rate. So patient was diagnosed as Complete Heart Block.

Fig. 1: ECG on admission – Bradycardia HR- 22 beats/min. the P waves are not related to the QRS complexes; patient diagnosed as complete heart block.

Fig. 2: Temporary pacemaker insertion procedure done on 01-07-2022. Right femoral vein approach; temporary lead inserted and fixed at RV apex. Set rate-80 beats/min.

Fig. 3. ECG taken post TPI insertion; Heart Rate was 50 beats/min.

As the patient was in continuous bradycardia of HR â€“ 48b/min. So he was planned for Permanent pacemaker insertion (PPI).

Fig. 4. Permanent Pace Maker insertion with VVI Mode is shown in the picture.

Fig. 5. PPI report sheet on 6th of August with stable Heart rate.

Fig. 6. Medtronic Micra AV pacemaker is an advanced device, weight less and non-allergic to patient. Weight=1.75gm, volume-0.8cc, wireless, longevity-13yrs, safely scan a pacing system.

Fig. 7. ECG findings post permanent pacemaker insertion; Patient was stable with heart rate 78-80 beats/min maintained.

Table 1: Vital parameters

Date	Heart Rate (beats/min)	SpO2 (%)	BP (mmhg)	RR (breath/min)	Input/Output (ml)
1st Aug	20	97	100/60	22	1150/1012
2nd Aug	70	98	110/80	18	1200/1070
3rd Aug	68	96	120/80	20	1057/1070
4th Aug	64	94	120/70	18	1200/1300
5th Aug	48	97	110/80	22	1250/1300
6th Aug	60	96	120/70	20	1350/1550
7th &8th Aug	78	96	120/90	18	1250/1500

Post procedure was eventful. Wound was healthy, patient improved symptomatically. He was discharged after a brief period of observation, with stable vital signs. He would however be visiting the hospital to get the device monitored over the coming months.

Nursing Care

Monitored the vital signs HR-74b/min after PPI
Placed the patient on a continuous cardiac monitoring for heart rate
Obtained an ECG
Assessed oxygenation therapy
Checked lab investigation to ensure electrolytes are within normal limits
Placed the patient at strict bed rest
Auscultation done to the heart for murmur sounds
Monitored for fluid retention- input & output maintained
Checked the patient weight -60kg
Put on hold any cardiac medications that can disrupt cardiac rhythm
Educated the patient about pacemakers, microwaves and TSA security checks which can cause magnetic interference with the pacemaker
Asked the patient to wear a medical alert bracelet
Health education given on diet plan & restrictions, and to report any abnormal symptoms by visiting doctor.

Acknowledgment

We thank our ever-supporting management who had backed us to deliver high class services at Salem. I thank the doctors’ team for proposing the idea, and I am also indebted to the patient’s confidence reposed in us. I thank our Nursing, Cath lab team who have been very supportive in managing challenging interventions.

References

Batra AS, et al. Fetal arrhythmias: diagnosis and management. Indian Pacing Electrophysiology J. 2019;19(3):104-9.
Batra AS, et al. Fetal arrhythmias: diagnosis and management. Indian Pacing Electrophysiology J. 2019;19(3):104-9.
Ellenbogen KA, et al. Clinical cardiac pacing, defibrillation, and resynchronization therapy. 5thedition. Philadelphia: WB Saunders Company; 2017.

L. Indumathi

Nurse Educator

Wireless moonlight: An ultra-short case study

L. Indumathi

Wireless moonlight: An ultra-short case study

Case Presentation

Vital signs on admission

Table 1: Vital parameters

Nursing Care

Acknowledgment

References

L. Indumathi

Nightingale Journals