Cardio 4
- Created by: Mohsin
- Created on: 10-04-18 13:22
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- Cardio 4
- Drugs modifying ECG Patterns
- Beta-adrenoceptorantagonists
- cause bradycardia and AV nodal conduction block
- Amiodarone
- causes sinus bradycardia, QT interval prolongation,prolonged PR interval, prominence of U wave
- Digoxin
- causes down sloped ST depression, shortened QT interval and flattened T waves
- Amitriptyline
- causes sodium channel blocking
- sinus tachycardia
- causes sodium channel blocking
- Beta-adrenoceptorantagonists
- Treatment- antidysrhymicdrugs
- Vaughan-Williams classification
- class 1
- class 1b
- Lidocaine
- treat and prevent V tachycardia and fibrillation after MI
- Given IV as first pass metabolism may occur
- treat and prevent V tachycardia and fibrillation after MI
- Lidocaine
- class 1a
- Disopyramide
- atropine like effect can cause blurred vision, dry mouth and urinary tract infections
- Disopyramide
- class 1c
- Flecainide and Propafenone
- Flecainide used in prophylaxis against paroxysmal AF
- Flecainide and Propafenone
- bind to alpha sub units and inhibit action potential propagation
- reduce re-entry
- decrease rapid depolarisation
- class 1b
- class 2
- B-adrenoceptor antagonists
- Reduces nodal conduction
- decreases sympathetically induced after depolarisation
- block sympathetic activity - reduce rate and contraction
- increase refractory period of the AV node
- Propanolol and Timolol
- reduce mortality following MI
- prevent recurrence of paroxysmal AF p
- provoked by increased sympathetic activity
- adverse effects
- worsening bronchospasm (asthma patients), bradycardia and fatigue
- B-adrenoceptor antagonists
- class 3
- prolong cardiac AP
- involves blocking K+ channels - depolarisation
- prevent re-entry
- involves blocking K+ channels - depolarisation
- Amiodarone
- tachycardia
- measure plasma electrolyte conc. K+
- Adverse effects
- slate grey/bluish discolouration to the skin, photosensitive skin rashes, thyroid abnormalities (iodine content)
- Adverse effects
- measure plasma electrolyte conc. K+
- tachycardia
- Stotalol
- paroxysmal supra-ventricular dysrhythmias and surpasses ventricular ectopic beats
- racemic stall prescribed
- monitor K+ levels
- adverse effects
- can cause Torsades de pointes
- adverse effects
- monitor K+ levels
- racemic stall prescribed
- paroxysmal supra-ventricular dysrhythmias and surpasses ventricular ectopic beats
- prolong cardiac AP
- class 4
- Calcium antagonists/ CCB
- block voltage sensitive calcium channels
- slow conduction in the SA and AV node
- reduce force of contraction
- Negative inotropic effect
- reduce force of contraction
- slow conduction in the SA and AV node
- Verapamil
- to prevent recurrence of paroxysmal (sudden) SVT
- reduces ventricular rate in patients with AF
- Given orally (IV is dangerous)
- reduces ventricular rate in patients with AF
- to prevent recurrence of paroxysmal (sudden) SVT
- Diltiazem
- effective on SM
- produces less bradycardia
- effective on SM
- block voltage sensitive calcium channels
- Calcium antagonists/ CCB
- class 1
- Vaughan-Williams classification
- NICE treatment for AF
- Aim = to prevent stroke and alleviate symptoms
- Diagnosis and assessment
- Manual pulse palpitations
- ECG
- patients with paroxysmal AF undetected by ECG
- 24 hour ambulatory ECG
- event recorder ECG - with episodes more than 24 hours apart
- Stroke and bleeding risk
- stroke = CHA2DS2-VASc
- Scale (1-9) for patients with paroxysmal, persistent AF, atrial flutter, risk of recurrence after cardioversion
- bleeding risk= HAS-BLED score
- used for people starting anti-coagulation
- stroke = CHA2DS2-VASc
- Treatment of AF
- new onset AF
- if not receiving any other anticoagulant treat with HEPARIN
- until further assessment
- if not receiving any other anticoagulant treat with HEPARIN
- First line
- rhythm control
- B-blockers / CCB
- Digoxin for patients with non-paroxysm AF (only if they do little exercise)
- Mono therapy doesn't work then combo of either B-blocker, diltiazem or digoxin
- Amiodarone is not offered for long term rate control
- Mono therapy doesn't work then combo of either B-blocker, diltiazem or digoxin
- rhythm control
- new onset AF
- Drugs modifying ECG Patterns
- Anti- coagulation in AF
- offered to patients with a stroke risk of 2 or more (Men 1 or more)
- Apixaban
- used to treat non-valvular AF
- Dabigatran
- Rivoraxaban
- in patients with 1 or more risk factors
- used to treat non-valvular AF
- Rivoraxaban
- Dabigatran
- Apixaban
- Risk factors
- prior stroke, TIA
- Hypertension
- aged over 75
- Diabetes
- Aged 65 or over with diabetes, CAD or hypertension
- symptomatic heart failure
- Vit K antagonists
- Therapeutic range first calculated
- coagulation reassessed for patients with poor control
- TTR less than 65%
- coagulation reassessed for patients with poor control
- Therapeutic range first calculated
- Antiplatelet
- aspirin mono therapy
- not offered for stroke prevention in patients with AF
- aspirin mono therapy
- Dronedarone
- recommend for the maintenance of sinus rhythm
- after successful cardioversion in people with paroxysmal or persistent AF
- if first line therapy doesn't work
- after successful cardioversion in people with paroxysmal or persistent AF
- similar to amiodarone but with less SE
- recommend for the maintenance of sinus rhythm
- offered to patients with a stroke risk of 2 or more (Men 1 or more)
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