Friday, March 25, 2011
Heart Rate Roller Coaster
Lillian is having an issue where her heart rate jumps extremely high (in the 220 bpm range) suddenly and drops quickly. We're not panicked about it, but we do have an extensive ECG setup on her right now (as you can see above) to try and catch it. These issues are normal post op, and we would hope to see it settle down 24 to 48 hours after surgery (she is as I type this 21 hours post op).
Part of the reason for the rate issues is that her brain needs to get used to new ways of controlling her heart. Since we removed most of her old heart, she has lost electrical control of the vast majority of her heart. To illustrate a common effect of this, consider how your heart rate jumps if you get scared. In that scenario, the brain sends the electrical currents for the heart rate to increase. Lillian's brain will still send these commands, but there's nothing on the other end to answer, so nothing will happen. Her heart rate in the long run shouldn't have rapid changes and will have to ramp up and ramp down.
We hope to see these issues disappear in the next couple of days, as they are normally caused simply by the trauma the new heart has been through. Just to be safe though, we are starting a Lidocaine drip which will help decrease the "fussiness" of the new heart. Once we have her rhythm and heart rate under control, we hope to extubate her, probably later today or tomorrow. Until we do have it under control, she will continue to be NPO (no food or fluids), although we hope to restart her feeds rather then go to TPN once she is extubated.
Just a quick overview of a couple other things: Lillian has 3 lines in and 3 lines out in addition to the pacer wires. The lines out are all drainage tubes, but she has been doing phenomenally with very little bleeding. In terms of lines in, she still has the PICC line in her left femoral artery, which we are using to deliver continuous medicines, right now consisting of Milrinone (she will be on this for a while still, and we are concentrating it later) and Morphine, and occasionally Nipride (sodium nitroprusside; regulates her blood pressure) when she needs it. She also has aline in her neck which we are using as a bolus med line, and a LA line which goes to her left atrium to monitor her heart.We have a NG tube in, but it is to control air and bile in her stomach rather than for feeding. She also has an arterial line in her left hand which we are using for continuous blood pressure monitoring. Nothing is being delivered through this line, we're only using it for blood pressure.
We are looking into removing the LA line tomorrow, so we will also need to either order more blood in or make sure we have enough here, as there's always the risk of bleeding when pulling a line out of her heart.