Four clients in the emergency room are having chest pain. The nurse knows that which of the following accompanying chest pain would be the most concerning?
a. Supraventricular tachycardia, BP 92/48
b. A seat belt sign, RR 22
c. Atrial fibrillation, HR 96
d. Shortness of breath, SpO2 92%
a. Supraventricular tachycardia, BP 92/48
rationale: A client with supraventricular tachycardia (SVT) and chest pain is urgent because the chest pain indicates that the coronary arteries are not perfusing properly. This is the main concern with extremely fast heart rates like SVT, the heart perfuses itself during diastole - but with a high rate, the diastole period is extremely short and risks decreasing coronary perfusion. Even more concerning is the slight hypotension accompanying this rhythm. This client needs to be converted back to a sinus rhythm as soon as possible to prevent an MI or cardiac arrest. Any client with chest pain needs to be seen quickly, including a client with chronic atrial fibrillation. This chest pain could be a sign of a clot having moved from the atria to the coronary arteries. However, SVT is more likely to precede cardiac arrest and therefore would take priority.
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