bradycardiaClass IV: Calcium Channel Blockers→ diltiazem (Cardizem)→ verapamil (Calan)Decrease automaticity of SA node, delay AV node conduction;reduce myocardial contractility Bradycardia, prolonged PR interval, AV blockOther antidysrhythmic drugs:→ adenosine (Adenocard)→ digoxin (Lanoxin)→ dronedarone (Multaq) [classes I-IV properties presentin this drug)→ magnesium→ decrease conduction through AV node, reduce contractility of SA node→ suppresses atrial dysrhythmias through an unknown mechanism→ prolonged PR interval, AV block→ Prolonged QT interal
→ decreases the impulse conduction through AV node→ AV block●Permanent pacemaker:○Implanted totally within the body○Pacing leads are placed transvenously to the right atrium and/or one or both ventricles and attached to the power source Temporary pace maker■Transvenous pacemaker consists of a lead or leads that arethreaded transvenously to the right atrium and/or right ventricle and attached to the external power sourcePacemakers:●Post-procedure care○OOB once stable○Limit arm and shoulder activity○Monitor insertion site for bleeding and infection○Patient teaching important○Do not take pulse/IV/BP on effected arm○Use cell phone on opposite side of pacemaker○NO MRIsACUTE CORNOARY SYNDROMEIt all starts with CADAtherosclerosisCADAcute Coronary Syndrome (MI)oUnstableoST will be elevated oCardiac cathallows us to visualize block and fix problem oIodine allergies!! They will feel a warm flushoHold metformin, blood thinnersoPost-op priority bleeding, have them lay down for 4-6 hrValve replacementoStenosis/regurgitationoLong-term valvesoLifelong anticoagulantsoNO MRI, airport security as magneticoInfections are harder to treatInfective EndocarditisoABX before any invasive proceduresoCauses: Mechanical valves, IV drug users
oJaneway lesions(not painful, on palms) and Osler’s nodes (painful fingertips)ACE Inhibitors(-pril)oDry cough, prevent remodeling of the heartRESPIRATORYPulmonary edemaPatho? oFluid in alveoli and interstitial spaces in lungsoAcute decompensated HFoComplication of heart and lung diseasesWhat causes it?oHF (Most common L-HF secondary to CAD)oOverhydrationoLow albumin, nephrotic syndrome, hepatic diseaseoARDSWhat are the symptoms? oIncrease pulmonary venous pressuresoIncrease RR, decreased pO2, oIncrease HR and BPoAnxiousoCold and clammyoSevere dyspneaoFrothy, blood tinged sputumoCrackles/wheezing/rhonchioJVDoBNP >500oDysrhythmiasTreatments?oFunds and MS1 interventions oLasixoBiPAP, mechanical ventilationoHemodynamic monitoring oMorphine/Nitro/Inotropic support/Anticoag.oVentricular assist device or intraaortic balloon pumpPleurisyInflammation of pleuraRF: Chest trauma, malignancies, chest tube insertion, pneumonia, and TBCXR can diagnose
S/S: Pain on inspiration, pleural friction rubTX: Steroids and NSAID’s Interventions: TCDBPleural EffusionCollection of fluid in pleural space
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