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an elderly woman in a nursing home has a fainting spell and is taken to the doctor.physical examination reveals a resting blood pressure of 130/60 mm hg and a heart rate of 40 bpm.which of the following is the most likely diagnosis?
a: aortic valve obstruction
b:cardiac tamponade
c:complete heart block
d:heart failure
e:mitral valvue obstruction
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| ssrpk
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c:complete heart block
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| ssrpk
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low heart rate is the clue!
OK guys, how wud u treat this pt.,?????
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| dreamer
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pacemaker..........
i actually wanna ask why the pulse pressure is increased in this pt??
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| ssrpk
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yeah pacemaker, and also atropine as a temporarizing agent!
well, low heart rate means , more preload on left ventricle, thus more stroke volume and therefore higher the systolic pressure, while again low heart rate means more time for the blood to clear up the arteries and therefore low diastolic pressure! kool huh!
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| dreamer
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so , what about the co? will it increase or decrease?
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| dreamer
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yeah, atropine.  how about dobutamine and NE?
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| ssrpk
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dobutamine is a very powerful drug which is basically kept reserved for shock state, but yeah can be used nonethelss, norepinephrine won't help as it wud raise the blood pressure and via barorecptor reflex mech. reduce the heart rate probably even further!
on the whole, these drugs won't be much effective as ventriclar pacemaker (purkinje firbers) do not receive as much sympathetic innervation as the SA node!
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| ssrpk
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cardiac output wud probably decrease particularly while the pt. is standing up or under stressful states as these are the situations which wud usually fire the SA node! but due to the heart block SA wud be unable to drive the ventricular rate higher! thus resulting in syncope!
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| mediocre
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I think the reason for a decrease in diastolic pr/contributing to incrs pulse pr. is the following
inrs in HR determines an shorter diastolic interval ie faster diastole
so a decrs in HR ud hav larger diast intvl ie slower diastole..,hows dat?
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