Archive for Adverse Drug Reactions

Cardiology- Day 15

June 14, 2010 at 6:09 pm · Filed under Adverse Drug Reactions, Clinical Interventions, Reflections on Residency & Learning

Ballon pump

  • rationale:
    • inflate during diastole (when aortic valve closes and EKG shows T wave)–> increase diastolic pressure–> increase tissue perfusion
    • deflate during systolie–> decrease systolic pressure–> decrease demand by decreasing afterload
Cardiac index greater than 2.2 Warm and dryNormal Warm and wetHFà diuresis
Cardiac index less than 2.2 Dry and coldFluids Cold and wetDiuresis and iontropesà cardiogenic shock
  Wedge less than 18 Wedge greater than 18
  • LA enlargement –> on AF for a longer period–> effect of remodelling

 GPIIb/IIIa in STEMI

  • Inhibit platelet aggregation by reversibly binding to the paltelet receptor glycoprotein IIb/IIIa of human platelets, thus preventing the binding of fibrinogen, von willebrand factor and other adhesive ligands
  • ClassIIa- abciximab or eptifibatide at time of primary PCI with or without stenting
  • ClassIIb- combination of abciximab and half dose reteplase or tenecteplase may be considered for prevention of reinfarction an other complication sof STEMI selected pt
  • not for pt greater than 75 years of age because increased risk of ICH

Rhabdomyolysis

  •  rapid breakdown (lysis) of skeletal muscle (rhabdomyo) due to injury to muscle tissue.
  • The destruction of the muscle leads to the release of the breakdown products of damaged muscle cells into the bloodstream; some of these, such as myoglobin (a protein), are harmful to the kidney and may lead to acute kidney failure. Treatment is with intravenous fluids, and dialysis or hemofiltration if necessary

What is the benefit of rate control in AF?

  • increase ventricular filling–> improving hemodynamics and decrease s/s
  • SYMPTOMATIC management
  • DOES NOT prevent AF
  • it only controls rate, NOT RHYTHM, so we didn’t restore the patient’s rhythm, pt can still be in afib

What is the benefit of rhythm control in AF?

  • works at restore sinus rhythm and prevent AF
  • if rate of spntaneous impulse generation of the abnormally automatic foci becomes less than that of SA node, normal cardiac rhythm can be restored
  • alter conduction characteristics of teh pathways of reentrant loops
  • if refractory period is prolonged without sig slowing conduction velocity, the tachycardia may terminate or slow in rate as consequence of a greater circuit length

Anticoagulation in pt with less than 48hr of AFIB who are cardioverted:

Although LA thrombus and systemic embolism have been documented in patients with AF of shorter duration, the need for anticoagulation in such patients is less clear. When acute AF produces hemodynamic instability, immediate cardioversion should not be delayed, but intravenous heparin or low-molecularweight heparin should be administered first.
Class IIb
1. Cardioversion without TEE guidance during thefirst 48 h after the onset of AF. (a. In these cases, anticoagulation before and aftercardioversion is optional, depending on assessmentof risk. (

 

Level of Evidence: C)

 

CHEST-For patients with AF of known duration < 48 h, we suggest cardioversion withoutanticoagulation (Grade 2C).- when only observational studies are available, or when they generalize from patients who were randomized in other population

 

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