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The Beats That My Heart Skipped

Posted by Allan MacRaild | 23 Jan 2017

The Beats That My Heart Skipped

Heartbeats provide the rhythm of life. Interruptions to this rhythm are more likely to lead to a loss of consciousness than just a loss of spark. Rob Hannigan (pictured with Senior Research Nurse Allan MacRaild) took part in the PATCH-ED trial in 2016 following a number of unexplained blackouts. The results of his PATCH highlighted some dangerous arrhythmias including 24 seconds when his heart stopped beating entirely. Six months after his participation in the PATCH-ED trial, Rob met up with Allan to share his experiences.

Blacking out

Rob was asked to recall the day of his collapse and to discuss the events that led to his arrival in the Emergency Department (ED). He was keen from the outset to provide more detailed context as this was his third blackout in two months. He had recently returned from South Africa and collapsed in the shower for no apparent reason. His G.P reassured him that this was likely a result of dehydration and tiredness but a few days later he blacked-out in the shower again. At this point, Rob became more concerned and began to think there might be a more serious cause. He attended the ED for further investigation but his blood tests were normal and his electrocardiogram (ECG) was unremarkable so Rob was sent home with a possible diagnosis of postural hypotension. Unexplained causes of collapse are common in syncope presentations as symptoms have often resolved before the patient reaches the ED. Indeed, the ambition to improve diagnosis and provide a better service for these patients is a central aim of the PATCH-ED trial. Two months later, the third blackout proved rather more serious. Rob was arriving at his office one morning. He had purchased a venti peppermint tea and caught the lift. His next memory was coming around in the office but in some degree of pain. He had blacked-out in the lift and scalded his arms and legs with his peppermint tea. Prompt dispatch to the ED led to a fateful meeting with the EMERGE research team

PATCH-ED

Once again Rob’s symptoms had resolved on arrival apart from significant burns which required dressing. Rob was by now very anxious as to the cause of these blackouts and so when he was approached by an EMERGE research nurse about a clinical trial for syncope; he (metaphorically) leapt at the chance to participate. PATCH-ED is a trial that investigates unexplained episodes of syncope through the use of an ambulatory cardiac monitor that patients wear for two weeks to continually monitor heart rate and rhythm. The monitor is discreet and features a button that patient’s can press if feeling symptomatic (eg. light-headed, dizzy, faint). Rob consented to participate in the trial and had the monitor applied. He reasoned that the monitor might provide the answers he needed. Curiosity and possible personal benefit was a motivating factor for participation though he also remarked that taking part might help someone else.

Monitored

When Rob returned home he felt he was not only being monitored by the PATCH. His episodes of syncope meant he could not drive and his wife was concerned about him being by himself in case he was to blackout again. The precautions he had to take and the uncertainty of his diagnosis significantly affected his quality of life. Rob continued to feel symptomatic after leaving hospital. He had a further blackout and frequently pressed the button on his PATCH. This was quite a change for someone in his early forties with a young family and a busy career life. Even here though there was a degree of irony; Rob works in risk management for a large bank! It was perhaps this professional background and Rob’s continued symptoms that led him to consult a private cardiologist before the results of his PATCH monitor were available. This consultation did not generate anything more than advice already provided on hydration and adding more salt to his diet. Rob was somewhat reassured unaware that a phone call the very next day would have a considerable impact on his healthcare.

Pacemaker

Rob was attending his daughter’s end of term church service when he received a phone call from Dr Matt Reed the chief investigator of the PATCH-ED trial. Rob recalls attending the ED that day with some trepidation as he was about to hear the results of his PATCH monitor. Matt met him immediately and explained that the results highlighted some dangerous arrhythmias and that the care plan for this diagnosis was the placement of a pacemaker. Cardiology took over Rob’s care at this point and he describes being put at ease and having the procedure explained clearly to him. The pacemaker was placed the following day and Rob’s recovery was very straightforward. Six months later he had his ‘MOT’ and the pacemaker is functioning well and producing impulses 7% of the time to ensure Rob’s heart keeps beating regularly.

Value of participating in research

Rob is very thankful for the PATCH-ED trial and is keenly aware of the positive impact it has had on his cardiac health. He remarked that he struggles to see the downside of participating in clinical research. PATCH-ED made him appreciate the value of research and he believes that “…in a crazy messed-up day [PATCH-ED] gave him hope…” It has also provided a good after dinner story!

For more information about the PATCH-ED trial, please contact Allan MacRaild on allan.macraild@nhslothian.scot.nhs.uk

Autumn 2017 EMERGE Newsletter now out! Dr Dave Caesar on Purpose & Mindset

Dr Dave Caesar on Purpose & Mindset

10 Aug 2017 | Miranda Odam

Nelson Mandela once said: “What counts in life is not the mere fact that we have lived. It is the difference we have made to the lives of others that will determine the significance of the life we lead.” So what does that mean to us in the Emergency Department? How can we make a difference? There are two factors that I think are really important: purpose and mindset. As clinicians, our purpose is to improve the health and wellbeing of our patients. We all know that this can be harder than it sounds, and that looking after ourselves is also important. Getting the right balance is extremely rewarding, and often requires a degree of support as well as “stretch”. It also requires understanding the effects our decisions, our care, and our treatments have on our patients. How do we really know if something has worked? Could we do this any better? This is where we need the right mindset. The mindset of learners. The GROWTH mindset. Teams with the growth mindset embrace challenges, learn from feedback, persist in the face of setbacks, learn from failure and are inspired by successes, are persistent and want to keep learning. These teams GROW, and individuals develop within them. Teams like this ask the right questions to fulfil their purpose, to improve their understanding and further their knowledge to make a bigger difference to the lives of others and themselves. EMERGE help us in the ED to do this. They help drive our curiosity, stimulate our thinking, stretch our perspectives, and contribute to our growth mindset. There is a Maori saying: “Learning brings greater knowledge, Knowledge brings greater understanding, Understanding brings greater wisdom, Wisdom brings greater wellbeing.” Learning is good for us all.

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TEDxNHS – #InspiredByPeople

TEDxNHS – #InspiredByPeople

8 Aug 2017 | Miranda Odam

When: Tuesday 15th August 2017 Time: 2pm - 8pm (drop in or stay) Where: Lecture Theatre B, Chancellors Building RIE TEDxNHS is a an event for those who work in the NHS live streamed in all four nations of the UK. The ebvent is independently organised and under license from TED. EMERGE (Emergency Medicine Resarch group of Edinburgh) are hosting on behalf of NHS Lothian and we would love you to join us to be inspired by a huge variey of speakers from a blind autistic savant and musical prodigy to a European Space Agency research doctor by way of a clinical entrepreneur and renaissance surgeon. Please contact Emma.Ward@nhslothian.scot.nhs.uk or call 0131 242 3863 to reserve your seat Looking forward to seeing you there!!

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