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| Ventricular tachycardia has __ complex QRS. |
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| Supraventricular tachycardia has __ complex QRS. |
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| Non-drug option for treatment of Supraventricular Tachycardia (SVT): |
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Definition
Vagal maneuvers: hold breath, valsalva maneuver
Carotid massage |
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| SVT treatment options when vagal maneuveres do not work: |
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Definition
- Short term control: 6 mg IV Adenosine
- Calcium Channel Blockers: Verapmil, Diltiazem
- Beta Blokcers (slower than CCBs): Esmolol, Metroprolol Tartrate |
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| With the treatment of Atrial fibrillation and atrial flutter, the goal is to control ___ __ and prevent __ __. |
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Definition
- ventricular rate
- emoblic complications |
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| Treatment options for Atrial Flutter and Atrial Fibrillation: |
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Definition
- Calcium channel blockers
- Digoxin
- Amiodarone
may have to use electrical cardioversion to restore sinus rhythm
- Beta blockers |
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| Wide complex tachycardia, aka __ __, in a stable patient should be treated with __ ___, __, or ___. __ should be used in patients with heart failure or structural heart disease. |
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Definition
- Ventricular tachycardia (b/c wide complex)
- IV procainamide, propafenone, or flecainide
- Amiodarone |
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| Unstable wide complex VT should be treated with: |
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Definition
- Adenosine- to test be careful though
- Immediate cardioversion |
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| Common presenting symptoms of paroxysmal supraventricular tachycardia from most common to least common: |
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Definition
1. Palpitations
2. Dizziness
3. Shortness of Breath
4. Syncope
5. Chest pain
6. Fatigue
7 Diaphoresis
8. Nausea |
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- heart rate greater than 100 bpm
- p waves similar to sinus rhythm |
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| Sinus Node Reentrant Tachycardia: |
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Definition
- p waves similar to sinus rhythm
- abrupt onset and offset |
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Definition
- Heart rate 120-250 bpm
- P wave morphology different than sinus rhythm
- Long RP interval
- Tachycardia not terminated by AV block |
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| Multifocal Atrial Tachycardia on EKG: |
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Definition
- Heart rate 100-200 bpm
- 3 or more different P wave morphologies |
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Definition
- Heart rate 200-300 bpm
- AV conduction 2:1 or 4:1 |
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| Atrial Fibrillation on EKG: |
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Definition
- irregularly irregular rhythm
- lack of discernable P waves |
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| AV Nodal Reentrant Tachycardia: |
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Definition
- Heart rate 150-200 bpm
- P wave either within the QRS or shortly after
- Short RP interval in typical AVNRT, long RP interval in atypcial AVNRT |
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| AV Reentrant Tachycardia on EKG: |
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Definition
- Heart rate 150-250 bpm
- Narrow QRS in orthodromic conduction
- Wide QRS in antidromic conduction
- Dx excluded by AV block during SVT
- P wave after QRS |
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Term
| How do you exclude dx of AV Reentrant Tachycardia: |
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Definition
| - if there is an AV block during SVT then it is not AV reentrant tachycardia |
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| List the different types of Supraventricular Tachycardias (SVTs): |
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Definition
- Sinus tachycardia
- Inappropriate sinus tachycardia
- Sinus node reentrant tachycardia
- Atrial Tachycardia
- Multifocal Atrial Tachycardia
- Atrial Flutter
- Atrial Fibrillation
- AV Nodal Reentrant Tachycardia
- AV Reentrant Tachycardia |
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| Paroxysmal SVT can lead to: |
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Definition
- Heart Failure
- Pulmonary Edema
- Myocardial Ischemia
- Myocardial Infarction
Chronic SVT can cause cardiomyopathy |
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Definition
- target end organ damage
- systolic > 220 OR
- diastolic > 125 |
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- greater than 180/110
- symptoms are NOT progressive and there is not end organ damage |
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| Malignant hypertension is usually associated with __ __ and is characterized by ___ and ___ due to __ in ___. |
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Definition
- renal disease
- hemolysis and thrombocytopenia
- necrosis in arterioles |
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| End Organ Damage due to HTNsive emergency, from most common to least common: |
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Definition
1. Cerebral Infarction
2. Hypertensive Encephalopathy
3. Acute Heart Failure Syndrome
4. Acute Coronary Syndrome
5. Intracerebral/Subdural Bleed
6. Aortic Dissection |
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| Under normal circumstances, with an increase in blood pressure, the cerebral arterioles __ and cerebral blood flow stays the same. But during HTNsive emergencies, the elevated BP overwhelms autoregulation causing ___ leakage across capillaries and continued arteriole damage. This leads to __, the sine qua non of malignant HTN. The end result is __ __. |
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Definition
- constrict
- transudate
- PAPILLEDMA- sin quo non
- hypertensive encephalopathy |
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| Signs of HTNsive encephalopathy: |
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Definition
- Headaches
- Irritability
- Confusion
- Somnolence |
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| With HTNsive emergencies the heart is experiencing an increased ___ which leads to increased oxygen demand and __, this eventually can cause __ __, __ __, or __. |
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Definition
- workload
- ischemia
- pulmonary edema
- myocardial ischmia
- myocardial infarction |
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| With HTNsive emergencies the renal system undergoes ___ and __ __, and an overall impairment of the autoregulation. this can manifest itself as: |
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Definition
- arteriosclerosis and fibrinoid necrosis
- worsening renal function
- hematuria
- RBC cast formation
- proteinuria |
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Definition
- Papilledema (optic disc swelling)
- Cotton whool spots
- Hemorrhages
- Macular star |
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- more common in African Americans
- males at greater risk for HTNsive emergencies than females
- most commonly in middle aged (40s-50s) |
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| Explain Cushing's Reflex: |
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Definition
| brain hemorrhage> space occupying lesion in the brain> pushes against the brain> decreased blood flow to the brain> ischemia to the brain tells body that brain isn't getting enough blood> increased pressure> increased bleeding etc. etc. |
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| Work-up in pt with HTNsive emergency: |
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Definition
- CBC
- Chemistry
- UA
- Pregnancy test
- CXR, Head CT, Chest CT, aortic angiogram
- EKG, cardiac enzymes |
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| In a HTNsive emergency, the blood pressure should be lowerd by __ of the mean arterial pressure. |
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Definition
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| 2 main classes of drugs to lower blood pressure in the ER; |
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Definition
- Vasodilators
- Anti-Adrenergic Agents |
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| 4 vasodilators that are good to use in ER to lower bp with HTNsive emergencies: |
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Definition
- Nitroprusside
- Nicardipine
- Enalapril
- Fenoldopam
(Don't use nitroglycerin or hydralizine in these cases b/c bp will drop too rapidly) |
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| Nitroprusside is a vasodilator that can be given in HTNsive emergencies. Give the dosage, onset, and adverse effects: |
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Definition
Dosage: 0.25-10mcg/kg/min
Instant onset 1-2 minutes
Adverse effects: cyanide poisoning |
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| Nicardipine is a vasodilator that can be used in HTNsive emergencies. Give the dosage, onset, and adverse effects: |
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Definition
Dosage: 5-15 mg/hr
Onset/duration: 5-10 min/1-4 hours
Side effects: Tachycardia, flushing
AVOID WITH HEART FAILURE |
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| Enalapril is an ACE-I vasodilator used in HTNsive emergencies. Dosage, onset/duration, side effects: |
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Definition
dosage: 10-40 mg IM, 1.25-5 mgIVq6hours
onset: 20-30 min/6 hours
SE: hypotension, renal failure, hyperkalemia |
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| Fenoldopam is a ___ ___ vasodilator used in HTNsive emergencies. Dosage, onset/duration, side effects: |
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Definition
- dopamine 1 agonist
- dosage: 0.1-0.3 mcg/kg/min
- onset/duation: 20-30 min/6 hours
- SE: flushing, headache, tachycardia |
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| Name 3 adrenergic antagonists that can be used with HTNsive emergencies: |
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Definition
- Labetalol (alpha1, beta 1 and 2 blocker), some sympathomimetic effect
- Esmolol- beta-1 selective blocker
- Phentolamine- alpha 1 blocker |
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| Adverse effects of Labetalol: |
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Definition
- heart block
- orthostatic hypotension
- avoid in heart failure and asthma |
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- hypotension
- avoid with heart failure and asthma
very short acting |
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- tachycardia
- flushing
- headache
can use this one in asthma b/c only block alpha 1 receptors, no effect on beta receptors |
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| Oral drugs that can be used in HTNsive emergencies: |
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Definition
- Captopril- ACE-I
- Clonidine- central acting alpha 2 agonist
- Labetalol |
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Definition
hypotension in high renin states
benefit: very short acting |
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- dry mouth
- sedation
- bradycardia |
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Definition
- heart failure
- heart block
- bronchospasm |
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| How to rapidly reduce bp with acute myocardial ischemia? |
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Definition
| - IV nitroglycerin, beta blockers, ACE-inhibitors |
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| How to rapidly reduce bp in pt with CHF with pumonary edema: |
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Definition
| - IV nitroglycerin, furosemide, morphine |
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| How to rapidly reduce bp in acute aortic dissection: |
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Definition
- IV nitroprusside + beta blocker
OR
- IV trimethaphan + beta blocker |
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| How to rapidly decrease bp with hypertensive encephalopathy or SA hemorrhage: |
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Definition
| - IV nitroprusside, labetalol or nimodipine |
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Term
| How to rapidly reduce bp with MAO tyramine interactions with acute HTN: |
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Definition
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