Sudden Shortness of Breath and Anxiety

Kozik, Teri M.; Pelter, Michele M.; Al-Zaiti, Salah S.; Carey, Mary G.

doi:10.4037/ajcc2012340

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ECG Puzzler| November 01 2012

Sudden Shortness of Breath and Anxiety

Teri M. Kozik, RN, CNS, PhD;

Teri M. Kozik, RN, CNS, PhD

Teri Kozik is supervisor of cardiac research at St. Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno. Salah S. Al-Zaiti is a doctoral student and Mary G. Carey is an associate professor at the School of Nursing at the State University of New York at Buffalo.

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Michele M. Pelter, RN, PhD;

Michele M. Pelter, RN, PhD

Teri Kozik is supervisor of cardiac research at St. Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno. Salah S. Al-Zaiti is a doctoral student and Mary G. Carey is an associate professor at the School of Nursing at the State University of New York at Buffalo.

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Salah S. Al-Zaiti, RN, NP;

Salah S. Al-Zaiti, RN, NP

Teri Kozik is supervisor of cardiac research at St. Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno. Salah S. Al-Zaiti is a doctoral student and Mary G. Carey is an associate professor at the School of Nursing at the State University of New York at Buffalo.

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Mary G. Carey, RN, CNS, PhD

Teri Kozik is supervisor of cardiac research at St. Joseph’s Medical Center, Stockton, California. Michele M. Pelter is an assistant professor at the Orvis School of Nursing, University of Nevada, Reno. Salah S. Al-Zaiti is a doctoral student and Mary G. Carey is an associate professor at the School of Nursing at the State University of New York at Buffalo.

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Am J Crit Care (2012) 21 (6): 453–454.

https://doi.org/10.4037/ajcc2012340

Scenario: An 86-year-old female was admitted to a medical-surgical unit from an extended care facility with complaints of abdominal pain and vomiting. She remained on complete bed rest due to severe pain and was ultimately diagnosed with acute sigmoid diverticulitis. After 4 days, an ECG (below) was obtained when she suddenly became anxious, short of breath, and hypoxic. On admission, her ECG showed normal sinus rhythm (76/min) with a right bundle branch block (RBBB).

Sinus tachycardia with an RBBB (criteria: QRSd > 120 milliseconds, slurred S wave in leads I and V₆, rSR′ pattern in V₁, where R′ > R) and ECG criteria suggestive of pulmonary embolism (PE)

A PE is an unpredictable condition associated with high morbidity and mortality in hospitalized patients.

Following a PE, acute hypoxia develops and fluid volume overload in the right ventricle (acute core pulmonale) occurs. Key ECG features include tachycardia,...

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