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Question
Mary Johnson is a 90-year-old woman brought to the hospital by her daughter with complaints of with fatigue, dizziness, and confusion. On initial assessment, Mary was oriented x 4, pale and weak. VS were HR 33, RR 20, pulse ox 94%, BP 96/70, and T 98.2F. An ECG shows Complete Heart Block (CHB). CHB, also called 3rd degree block, is a serious bradycardia. It occurs when none of the electrical impulses that originate in the SA node, atria, or AV node reach the ventricles. As a result, a ventricular cell is pacing the heart. The patient's cardiac output is compromised and the ability to perform ADLs is usually limited. Without treatment the heart will cease beating. The one-year survival rate is 50% if no pacemaker is used. Mary has a do not resuscitate order written by her primary care physician. She is negative for acute MI. The cardiologist is recommending a permanent pacemaker to treat Mary's condition. Mary has an advanced directive that states no artificial life support. She had a sister who had a severe stroke and was unresponsive on mechanical ventilation for 2 months. Mary states she does not want to be kept alive on machines like her.
This is the hardest working cardiac chamber and therefore has the thickest myocardium. Blood flows from the right atrium through this atrioventricular valve to the right ventricle.
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