Tuesday, January 14, 2014

Why We All Need to Learn to Take a Nightly Pulse


Note that the person taking the pulse is not using their thumb.  Using the thumb could result in their taking their own pulse, and not accurately obtaining the pulse of the person they intend.

         Heart rhythm disturbances are a fairly common occurrence.   Occasionally, even healthy people who have diarrhea or vomiting, develop a fluid and electrolyte disturbance which results in a heart rhythm disturbance.    The most common type of rhythm disturbance is something called atrial fibrillation, which I have discussed here before.   I will provide the links to my prior posts on this subject, but today I wish to talk about proactive steps families can take to detect heart rhythm disturbances.

                    A sudden heart rhythm disturbance took the life of my youngest son Daniel at age 12 1/2, five years ago, at the beginning of the Christmas season.   He had been well with no prior medical history, and had a clean physical some weeks earlier.  In the last few years, an increasing number of children and teens have been collapsing and dying, often  at sporting events as a result of a spontaneous heart rhythm disturbance. (SADS)    Many of these children and teens, like Daniel, never had any symptoms prior to the event which took their lives.  This has also happened to professional soccer players and to both college and professional baseball and football players.  We cannot detect and intervene effectively enough to stop ALL of these deaths, but we can detect some rhythm disturbances, and if detected, we can seek treatment, and perhaps prevent the tragedy which has forever changed the configuration and the future of my own family.

Daniel would want you to know how to determine your own pulse, and to know how to determine whether it is regular or not.

                    ALL people, aged 12 and older should be taught to be able to take a pulse.  There are multiple pulse points over the body, but for our purposes here, the most constructive one for screening purposes is the radial arterial pulse, which is shown at the top of this post. You should practice locating this pulse point on all your family members.  Once you can consistently detect the pulse, use a watch or clock with a second hand to count the pulse for fifteen seconds. If you don't have one, Wal-Mart sells a watch with a second hand for nine dollars or so.    If is is completely regular, then multiply it by four, and this is that family members radial pulse beats per minute.    For example, twenty regular beats in fifteen seconds would be multiplied by four to become a pulse of eighty beats per minute  (80 bpm) which would be normal for many people. 

           A pulse should be like this:


     This is a regular pulse.

However, sometimes a pulse, for some reason is irregular, something like this....


    This is an irregular pulse.

If you have a family member with a slightly irregular or severely irregular pulse, then you need to count their radial pulse for ONE FULL MINUTE.    Then report both the rate (the number of beats you determined during that one minute of pulse-taking) AND the fact that the pulse was irregular, to the primary physician of the person whose pulse you took.     If that person feels ill in addition to having an irregular pulse, then you need to call an ambulance and tell them the person has a "New Onset Irregular Pulse", and does not feel well.

          An irregular pulse may be an indicator of a number of different rhythm disorders, or arrhythmias.   A physician or cardiologist will need to determine which, following an EKG at either his office or the emergency room. Anyone with chest pain and an irregular pulse must go straight to the emergency room.

           For people aged 50 and older, an irregular pulse may be the first sign of the onset of a rhythm disturbance named atrial fibrillation.     Atrial fibrillation has an hereditary component, but may also occur in smokers, diabetics, or those with actual structural problems with the heart and vessels around it. Sometimes people with thyroid disorders will develop atrial fibrillation.   Atrial fibrillation can be treated and corrected in all but a few cases.  It is important to detect and treat a-fib because if left for a couple of days or more, the chance of that person having a stroke increases by four to five times normal.  Once diagnosed and treated, many people go on to live a normal life expectancy and feel quite well.     Intermittent atrial fibrillation can also go on to produce other arrhythmias which can be fatal.   Not everyone who has atrial fibrillation actually knows it, and so anyone over age 50 should take their pulse at bedtime before sleeping, every night.

           There are no specific recommendations for taking the pulse nightly or weekly for children, but after losing my youngest son to a disorder we never knew he had, I think it's a fair and reasonable thing to teach each child at 12 how to take a pulse, and teach them to take their own.   They may then have the tools to report a rhythm disturbance prior to a sudden arrhythmic death.    Daniel knew how to take a pulse, but never reported that his pulse was irregular at any time.  I never noticed an irregular pulse on him, and I did occasionally take one, because a rapid pulse can be an indicator of severe allergy, which he did have to certain foods when he was small.    I also recommend that all children age 12 and older have an EKG done prior to engaging in team sports.

           Atrial fibrillation is the most common rhythm disturbance in adults, however there are a number of disorders which can disrupt a healthy cardiac rhythm.     Some of these are Long QT Syndrome,  Short QT SyndromeBrugada Syndrome Wolff-Parkinson-White Syndrome,   CPVT, and others.    If you recognize any of these names as having been a diagnosis made on any of your family members, particularly if they died suddenly, then you too need to be checked for a heart rhythm disturbance.  Some viral syndromes can also cause spontaneous heart rhythm disturbances.

These are most of my posts on Rational Preparedness: The Blog which relate in some way to atrial fibrillation or  heart rhythm disturbances.:







BBC said...

As a young boy I had a heart murmur and they didn't expect me to live long, as a seventy year old man I'm always bothered by what disturbs me but like a good Timex watch I keep thumping along, go figure.

Life is uncertain, eat dessert first.

JaneofVirginia said...

Words to live by, for certain. Thanks for posting.