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79 Cards in this Set
- Front
- Back
Right Sided HF symptoms are seen where
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Peripherially
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What is Cardiac Output?
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volume of blood the heart expels per minute
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Dialated Cardiomyopathy
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*Impaired pumping action of the heart
*Most cases *Causes include ETOH abuse and chemo Pts. look like HF pts |
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S/S OF CARDIAC TAMPONADE
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BECKS TRIAD
1. Hypotension 2. JVD w/ clear lungs 3. Paradoxical Pulses |
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Extra complications of Pericarditis
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Pericardial Effusion & Cardiac tamponade
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NURSING CARE FOR PERICARDITIS
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Assess pain - MI or Pericarditis?
Auscultate for friction rub Position NSAIDS Assess for pulsus paradox & other S/S of cardiac tamponade |
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Central Venous Pressure (CVP)
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CVP measures preload and is used for the RIGHT side of the heart.
NORMAL VALUE: 2-8 mmHg ELOW 2: dehydration, blood loss ABOVE 8: Fluid Overload |
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clients with angina should seek medical attention if chest pain lasts longer than
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20 min
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do not give NTG to patient who presents with angina whose SBP is <
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90
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meds for angina
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-Heparin
-aspirin -beta blockers -ca+ channel blockers -nitrates (NTG) |
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during anginal pain episode, EKG shows
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-ST depression
-inverted T |
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1 risk for patients with aortic aneurysm
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hypovemia --> shock
-monitor VS -I&Os -Lab results -S/S of shock |
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drug therapy for abdominal aortic aneurysm
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- Oxycodone
-B-blockers (metoprolol, propanolol) -anti-hypertensives (minipress, Nitropress, NTG) |
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/S of abdominal aortic aneurysm
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-abdominal mass to the left of midline
-abdominal pulsations -bruits over the site of aneurysm -diminished femoral pulses -Lower back/abd pain -SBP in legs lower than SBP in arms |
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dissecting aneurysm
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aneurysm vessel wall ruptures and a blood clot is retained in an outpouching of tissue
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Pulse Deficit
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Radial pulse rate falls behind apical rate
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What dx are usually associated with S4 sounds?
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HTN, CAD, aortic stenosis, cardiomyopathy
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Prinzmetal’s (variant) Angina
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a variant form that is characterized by chest pain during rest and by an elevated ST segment during pain and that is typically caused by an obstructive lesion in the coronary artery
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Unstable Angina
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pain characterized by sudden changes (as an increase in the severity or length of anginal attacks or a decrease in the exertion required to precipitate an attack) especially when symptoms were previously stable
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What are the actions of Adenosine and therapeutic uses?
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Decreases automaticity, conduction velocity at the AV node.
Increases the refractory period at the AV node Used in treatment of paroxysmal supraventricular tachycardia Given as rapid IV bolus ONLY, followed by saline flush Continuous telemetry monitoring |
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What are the adverse effects of lidocaine (Xylocaine)?
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(Xylocaine)? Most common:
CV system (dysrhythmias and hypotension) CNS (dizziness/lightheadedness, fatigue, and drowsiness) Excessive levels can produce confusion and seizures. Monitor ECG continuously and switch to another dysrhythmic as soon as stable. |
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Atropine SO4
anticholinergic & Antiarrythmic |
decreases HR, BP, systemic vascular resistance.
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Vasopressin
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smooth muscle contraction of all areas of the vascular bed. can increase BP in hypotensive pt
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Lidocaine HCl
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decreases ventricular excitability
Antiarrhythmic |
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Dobutamine HCL
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ardiac stimulant, increases co, by improving stoke volume c min increase in hr, bp
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Dopamine HCL
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Vasopressure,cardiac stimulant corrects hemodynamic imbalances-bradycardia
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condition in which fluid in the pericardial cavity creates enough pressure to cause cardiac compression
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tamponade
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What are the symptoms of dilated cardiomyopathy?
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fatigue
weakness palpitations |
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What can cause CHF?
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coronary artery disease
past history of MI untreated hypertension valvular disease cardiomyopathy infection heart defect |
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What are the symptoms of mitral valve prolapse?
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many cases are asymptomatic
can cause: palpitations tachycardia light-headedness fatigue dyspnea |
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inflammation of the endocardium, especially the cardiac valves, caused by bacteria, viruses, fungi, parasites, etc. that get into the bloodstream
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nfective endocarditis
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What are the signs and symptoms of shock?
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tachycardia
very low BP cold and mild skin decreased capillary refill low urine output metabolic acidosis |
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What are the CM for cardiogenic shock?
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impaired mentation
systemic and pulmonary edema low cardiac output dusky skin color low BP oliguria ileus (intestinal obstruction) dyspnea |
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What is the cause of hypovolemic shock?
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loss of blood, plasma, or interstitial fluid in large amounts
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What are the seven serum markers of myocardial damage?
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Troponin (T and I)
- Creatine kinase (CK)-MB - Myoglobin - Serum lipids (Cholesterol, Triglycerides, HDLs, LDLs, HDL /LDL ratio) - Homocysteine - C-reactive protein (hsCRP) - Blood coagulation tests (PT,PTT,INR) |
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Troponin (T and I)
- Creatine kinase (CK)-MB - Myoglobin - Serum lipids (Cholesterol, Triglycerides, HDLs, LDLs, HDL /LDL ratio) - Homocysteine - C-reactive protein (hsCRP) - Blood coagulation tests (PT,PTT,INR) |
serum markers of an mi
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EKG changes:
What does ST depression indicate? |
Ischemia
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EKG changes:
What does ST segment elevation indicate? |
Injury
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lidocaine
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antiarrhtyhmic
Conversion of PSVT to sinus rhythm Contraindications Second- or third-degree AV block, or sick-sinus syndrome. Atrial flutter. Atrial fibrillation. Ventricular tachycardia. Hypersensitivity to adenosine Adverse Reactions Facial flushing Lightheadedness Paresthesia Headache Diaphoresis Palpitations Chest pain Hypotension Nausea Metallic taste Shortness of brea |
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amiodarone
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antiarrhymic
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atropine
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antarrhymic
Contraindications Tachycardia Hypersensitivity Unstable cardiovascular status in acute hemorrhage and myocardial ischemia Narrow-angle glaucoma Adverse Reactions Tachycardia Paradoxical bradycardia when pushed slowly or when used at doses less than 0.5 mg Palpitations Dysrhythmias Headache Dizziness Anticholinergic effects (dry mouth or nose, photophobia, blurred vision, urine retention) Nausea and vomiting Flushed, hot, dry skin Allergic reactions Hemodynamically significant bradycardia Asystole give 4 this |
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procanimide
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Indications
Suppressing PVCs refractory to lidocaine Suppressing ventricular tachycardia (with a pulse) refractory to lidocaine Suppressing ventricular fibrillation refractory to lidocaine when bretylium tosylate is not readily available PSVTs with wide-complex tachycardia of unknown origin (drug of choice when associated with WPW) Contraindications Second- and third-degree AV block Digitalis toxicity Torsades de pointes Adverse Reactions Hypotension Bradycardia Reflex tachycardia AV block Widened QRS Prolonged PR or QT interval PVCs Ventricular tachycardia, ventricular fibrillation, asystole CNS depression Confusion Seizure |
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digoxin (Lanoxin)
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cardiotonic - inotropic
Increases force of contraction, used in CHF |
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adenosine (Adenocard)
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antiarrhythmic
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atropine
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antiarrhythmics - anticholinergics
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Vasopressin considerations
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Only given one time. May cause cardiac ischemia and angina. May replace first or second dose of Epi. Not recommended for responsive patients with coronary artery disease.
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agnesium sulfate (electrolyte)
Indicated for? |
Cardiac arrest if torsades or Hypomagnesemia
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Lidocaine (antiarrhythmic)
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V-Fib/Pulseless V-Tach, Stable V-Tach
1-1.5 mg/kg |
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Dopamine (catecholamine
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Symptomatic Bradycardia, Hypotension
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Atropine (parasympathetic blocker)
Indicated for? |
radycardia
0.5 mg q 3-5 min as needed PEA, Asystole |
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What is acute coronary syndrome?
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Ischemic coronary events that may result in a blood supply and demand mismatch.
Stable and unstable angina pectoris. Myocardial infarction. |
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Characteristics of stable angina?
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INTERMITTENT chest pain (usually with exercise or exertion)
Episodes CONSISTENT in duration and intensity (usually only last a few minutes). CONTROLLABE with medications (ie nitroglycerine). Can develop into unstable angina. |
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Diagnostic studies for an MI:
Cardiac enzymes? |
CK-MB elevated (>5ng/mL)
Troponin I (>0.1 ng/mL) Myoglobin Myoglobin levels peak earlier, but Troponin is most frequently used to diagnose |
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EKG changes:
What does ST depression indicate? |
Ischemia
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EKG changes:
What does ST segment elevation indicate? |
Injury
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EKG changes:
STEMI v NSTEMI: STEMI characteristics? |
ST elevation MI
Tends to be more extensive COMPLETE coronary artery occlusion |
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Medical management of MI:
How do you-- reduce afterload? |
nitroprusside for short term
ACE inhibitors and ARBs for longer term |
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Medical management of MI:
How do you-- decrease preload |
nitrates, morphine, diuretics
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Heart Valves:
Name the two atrioventricular. |
mi tri
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Mitral valve regurgitation:
Clinical Manifestations: Chronic: List 5 possible manifestations. |
Asymptomatic/no Sx
2. Weakness, general malaise 3. Dyspnea (orthopnea/pnd) 4. PERIPHERAL edema (advance Sx) 5. S3 and murmur at apex |
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Mitral Valve Stenosis:
Clinical manifestations: Name 4 |
1. Dyspnea (hemoptysis)
2. Palpitations (A fib) 3. Diastolic murmur (apex) 4. Predisposed to EMBOLI |
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CVP (Central Venous Pressure)
What does it measure? |
The pressure of blood within the right atrium.
Used to approximate the right ventricular end diastolic pressure (RVEDP |
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CVP:
Normal values? High indicates? Low indicates? |
Normal 2-6 mmHg
High=overhydration, increased venous return or right sided cardiac failure. Low=hypovolemia or decreased venous return |
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Mean Arterial Pressure(MAP):
What is it? Normal range? |
Reflects changes in the relationship between cardiac output (CO) and systemic vascular resistance (SVR) and reflects the arterial pressure in the vessels perfusing the organs.
70-100 mmHg |
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Platelets
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140,000-340,000/mm3
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PT
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10-12
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INR
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2-3 for patients on coumadin therapy
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no P waves on the ECG
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svt
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cardiac tamponade
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medical emergency condition where liquid accumulates in the pericardium in a relatively short time. The elevated pericardial pressure prevents proper filling of heart cavities. Instead of reducing the filling of both ventricles equally, the septum of the heart will bend into either the left or right ventricle. The end result is low stroke volume, shock and often death
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True/False a pacemaker is senstivie to magnetic fields
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True, should not be exposed to these fields for more than a few seconds, avoid welding or chain saws, no gasoline powered tools, carry medical alert especially in airports inorder to be hand searched.
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Arteriosclerosis
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hardening that affects the small arterioles
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Teaching on Beta blockers
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symptoms may worsen and may take a few weeks before improvement in cardiac status, meds are titrated slowly
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signs of hypokalemia
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weak pulse, faint heart sounds, hypotension, muscle flabbiness, diminished deep tendon reflexes and generalized weakness
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signs and symptoms of hyponatremia
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pprehension, weakness fatigue, malaise, muscle cramps and twitching and a rapid thready pulse
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dobutamine (Dobutrex) action
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ncrease cardiac contractility.
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A vasopressor is
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a drug used to constrict the arteries and increase blood pressure. These agents include dobutamine, dopamine, epinephrine, isoproterenol, norepinephrine, phenylephrine and ephedrine. They are most commonly used in intensive-care and post-operative hospital settings for patients with critical hypotension (low blood pressure)
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Right sided heart failure
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pedal edema
ascites hepatic congestio |
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Drug classes of
verapamil (Calan) |
Calcium channel-blocker
- Antianginal agent - Antiarrhythmic - Antihypertensive Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells |
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Desired actions of
verapamil (Calan) |
1. decreased cardiac workload
2. decrease oxygen demand 3. decreased cardiac energy consumption 4. increased delivery of oxygen to myocardial cells SVT too! |