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70 Cards in this Set
- Front
- Back
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What are the consequences of cardiac arrythmias |
Altered heart rate Decreased ventricular filling Decreased cardiac ejection Decreased efficiency |
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What is the most common cause of arrhythmia |
Coronary artery disease w/n conduction system and myocardium |
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Clinical consequences of atrial fibrillation |
Rapid heart rate Decreased ventricular filling Cardiac output |
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Symptoms of AF |
palpitations dyspnoea |
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Causes of AF |
IHD Thyrotoxicosis Rhumatic heart disease ( cohort passing on ) Cardiomyopathy - alcohol PE |
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Treatment Aims in AF |
Slow down ventricular response rate with drugs Eg digoxin, beta blockers, verapamil, amiodarone treat reversible symptoms eg thryotoxicosis reduce risk of thromboembolism wth warfarin Restore sinus rhythm with drugs / DC cardioversion |
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MOA of digoxin |
Inhibits Na+/K+ ATPase --> increased Na, increases ca2+ for contractile apparatus, increases force of ventricular pumping |
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What drugs have taken over digoxin in the heart failure treatment world |
Beta Blockers Ca channel antagonists |
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Adverse effects of digoxin |
UPSET GI SYSTEM NAUSEA, VISUAL DISTURBANCE YOU'RE YELLOW CAN CAUES TACHYARRYTHMIAS INTERACTION WITH DIURETICS BTW DIGOXIN HAS A LOW ti |
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MOA of atenolol |
Reduces affect of adrnealine by blocking beta adrenoreceptor blocking drug Realtively B1 selective Reduces sympathetic NS activity, reduces excitability of conduction system and decreases ventricular response rate |
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Name a non-selective Beta-adrenoreceptor blocker |
Propanolol |
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Name some adverse effects of atenolol |
LETHARGY BRONCHOSPASM HYPOTENSION HEART BLOCK DECREASE IN PERIPHERAL PERFUSION |
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Presentation of supraventricular tachycardia |
Palpitations Rapid regular pulse Can often affect younger patients |
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What goes wrong for supraventricular tachycardia to occur? |
RE-ENTRY Bypass tract, anatomical defect means you can conduct through from atria to ventricles Explained = if timing right , bypass tract may no longer be refractory or blocked by anterograde conduction --> retrogade conduction thorugh bypass tract sends onwards depolarisation through to AN, leads to circus activity, SAN out of the picture |
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How to terminate supraventricular tachycardia |
Vagal stimulation manoeuvres Carotid massage valsava - trying to exhale against a closed glottis Eyeball pressure Diving reflex or a damp lcoth might work |
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Immediate treatment of supraventricular tachycardia |
ADENOSINE - short acting, briefly slows down conduction through AVN node Causes hyperpolarisation of conduction tissue |
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Adverse effects of adenosine |
Chest pain Dizziness |
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Indications of adenosine |
Supraventricular tachycardia |
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What is verapamil |
Central calcium channel blocker |
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MOA of verapamil |
Works on voltage sensitive L-type Ca channels, decreased conduction through SA and AV nodes and decreases force of contraction of heart, causes peripheral vasodilatations |
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Indications of verapamil |
SVT
angina hypertension |
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Adverse effects of verapamil |
Constipation due to relaxation of GI smooth muscle Heart block Bradycardia Hypotension |
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What kind of patient should you NEVER give verapamil to?! |
A patient on beta blockers WHY ?! -- because of danger of precipitating asystolic cardiac arrest |
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Define ventricular tachycardia |
3 or more ventricular ectopic beats |
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What's the problem in ventricular tachycardia? |
Beats are driven from within the ventricles rather thanthe normal mechanism If sustained can lead to major haemodynamic disturbance with hypotension and heart failure |
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What is nearly always the cause of ventricular tachycardia? |
Myocardial Infarction |
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What is ventricular tachycardia commonly associated with |
Failing heart |
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Acute treatment of ventricular tachycardia |
Lidocaine is past tense Now we use amiodorane and potentially procainamide and disopyramide |
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If a patient is compromised how can you treat ventricular tachycardia? |
DC cardioversion |
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What kind of drug is lidocaine |
Class 1 membrane stabilising anti-arrhythmic drug |
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MOA of lidocaine |
Blocks Na+ channels in tissue, reduces excitability and cardiac conduction, -ve ionotrope |
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How do we administer lidocaine |
IV cos we need to pass first pass metabolism |
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Adverse effects of lidocaine |
Drowsiness, confusion, convulsions |
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What kind of drug is amiodorane |
Class III anti-arrythmic drug, prolongs action potential by blocking K+ channels |
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Adverse effects of amidarone |
Toxicity Reversible corneal microdeposits Photosensitivity Slate-grey discolouration Pnuemonitis Pulmonary fibrosis Peripheral neuropathy Thyroid dysfunction Heaptitis |
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How do you treat heart block |
Pacemaker / atropine |
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Class I drugs in Vaughan-williams classification |
they are MEMBRANE STABILISING DRUGS (block NA) A.quinidine, procainamide B.lidocaine, mexillitine C.flecainide |
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Class II drugs in Vaughan - Williams classification |
Beta-blocking drugs Atenolol |
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Class III (drugs that prolong cardiac action potential) |
Amiodarone, bretylium, sotalol |
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Class IV drug |
Verapamil - calcium channel blocker |
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Indications of ACE inhibitors |
Hypertension, heart failure, CV event prophylaxis, diabetic neuropathy, post MI |
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Adverse effects of ACE inhibitors |
Dry cough (10-15%) Hypotension Renal impairment Angioedema |
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Indication for Angiotensin Receptor Blockers |
Hypertension, diabetic neuropathy, heart failure |
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Adverse effects of ARBs |
Renal impairment Cough Hypotension |
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Indication for Atenolol |
Hypertension Angina MI Arrythmias Heart failure Thyrotoxicosis |
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Adverse effects of atenolol |
Bradycardia Heart failure/block Vasoconstriction Fatigue Erectile dysfunction |
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Contra-indications for beta blockers |
Asthma Heart block |
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Thiazide like diuretics indications |
hypertension oedema |
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Adverse effects of thiazide like diuretics |
Decreased - Na+, K+, Mg2+ Increased : Ca2+, urate, glucose and cholesterol Impotence |
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Contra-indications for thiazide like diuretics |
Gout Lithium treatment |
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Indications for Alpha 1 blockers |
Hypertension Raynaud's disease |
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Adverse effects of zosins |
Postural hypotension Dizziness |
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Contra-indications of zosins |
heart failure avoid in breast feeding |
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Indications for heparin |
DVT Thromboprophylaxis in surgical patients MI Pulmonary embolism Coronary artery disease |
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Adverse effects of heparin |
Haemorrhage Hyperkalaemia (inhibits aldosterone secretion) Thrombocytopenia (low platelet count) LMW --> osteoporosis |
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Contraindications of heparin |
Hepatic impairment renal impairment pregnancy/breast feeding |
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indications for DOACs |
DVT Pulmonary embolism MI AF to decrease stroke risk |
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Adverse effects of DOACs |
haemorrhage GI upset |
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Contraindicaitons of DOACs |
Bleeding conditions |
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Indications for warfarin |
DVT Pulmonary embolism AF Mechanical prosthetic heat valves |
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Adverse effects of warfarin |
Haemorrhage Nausea Vomiting Diarrhoea Hepatic dysfunction |
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Contra-indications for warfarin |
Haemorrhagic stroke Significant bleeding |
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what drugs increase myocardial contractility |
Digoxin Dobutamine |
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Class V antiarrhythmic drugs |
Digoxin and adenosine |
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Drugs for treatment of atrial fibrillation |
Atenolol Amiodarone Verapamil Digoxin |
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Drugs for treatment of SVT |
Adenosine for diagnosis, lidocaine, amiodarone, verapamil |
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Contra-indication for adenosine |
Renal failure Hypokalaemia |
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Treatment for Atrial fibrillation |
Amiodarone Atenolol Verapamil Digoxin |
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Treatment for SVT |
Adenosine Lidocaine Amiodarone Verapamil |
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Treatment for VF |
Lidocaine Amiodarone |
