5) AV & Blocks Flashcards
Junctional Arrhythmias:
(PJC) Premature Junctional Contractions
Junctional Escape Complexes and Rhythm
Junctional Bradycardia
Accelerated Junctional Rhythm
Junctional Tachycardia
Ventricles have more muscles so P wave
“eat P wave” if AV fires same as ventricles
Digoxin) Typically for:
Dynamics
works bc
= CHF
= allows more Ca for better contraction
= confuses K/Na pumps
“AV node P waves” morphology:
= inverted before QRS, hidden w/in QRS, after QRS
w/ (PJC) Premature Junctional Contraction) 1Rules:
2CANNOT HAVE B/C:
3Compensatory pause
4Non-compensatory pause
1= rate by rhythm, usually slightly irregular, P waves are either inverted before, +after, or hidden w/in QRS
2=have upright P wave (up P= PAC)
3= keeps cadence
4= doesn’t keep cadence
AV pacing site defined by:
= P wave: 1 inverted before QRS, 2 hidden w/in QRS, 3 +/- after S
(AV pace impulses relation w/ P waves)Atriums fire 1st then ventricles:
Atriums & Ventricles fire at same time:
Ventricles fire 1st then atriums fire 2nd:
= inverted P wave before QRS
= P wave hidden w/in QRD
= P wave after QRS (before T wave)
- (Junctional rhythms) aka know by:
- Definer:
1= junctional escape: “pick up workload b/c something failed”
2= AV P waves & AV node rate 40-60BPM, Regular rhythm
- (Junctional rhythms) aka know by:
- Definer:
- S/S:
- Rules:
- Treatment:
1= junctional escape “pick up workload b/c something failed”
2= AV P waves & AV node rate 40-60BPM, Regular rhythm
3= Slow heart rate can decrease CO; angina
4= AV: Pace site, rate, & P-waves> regular rhythm, can have >PRI
5= O2 as needed, 15 Lead ECG, underlying cause (MI commonly), If signs poor perfusion, prepare for transcutaneous pacing (TCP)
(Junctional Bradycardia) 1. Remember:
2. Rules:
3. Etiology:
4. S/S
5. Treatment of Symptom Stable:
6. Treat of Symptom Unstable:
1= AV inherit firing rate 40-60 so <40BPM AV Brady
2= <40BPM, REG/ rhythm, AV P waves, QRS WNL but can be wide
3= +Vagal nerve tone, Patho/ slowing of SA node rate
4= Decreased HR: decreased CO, hypotension, angina, CNS S/S
5= “table” treat w/ Med admin/ of pos/ underlying cause (SBP >90)
6= (SBP<90 or AMS) “go straight 8 Cables!” PPM 60-80, Pace ASAP to increase pacing’s efficiency
(Atropine & Dopamine) 1. Med/ Admin/ for:
2. Atropine dosing:
3. Dopamine dosing:
(Symptomatic unstable) 4. S/S: go Cables! EX unconscious, RR<4,
5. Treatment:
Mili Amps MA (need to touch PT to feel pulse)
Pace ASAP to increase chance of pacing
1 = SBP greater than 90mmHg, “Stable to the table”
2= 1mg 3-5mins as needed (0.04mg/Kg (total 3mg)
3= “Real”2-5mcg, BC>5-10mcg/kg/min, Vaso-press> 10-20 mcg/kg/min
4= inadequate perfusion: hypoBP, AMS, etc)
5= “Straight 8 Cables!” PPM 60-80, (TCP)Transcutaneous Pacing ASAP
(Heart Blocks Raps) If the R is far from the P, then you have a:
Longer, longer, longer, drop, then you have a:
If some Ps don’t get through, then you have a:
If Ps and Qs don’t agree, then you have a:
= FIRST DEGREE!
= WENCKEBACH!
= MOBITZ II!
= THIRD DEGREE!
(Heart Blocks Raps) If the R is far from the P, then you have a:
FIRST DEGREE!
(Heart Blocks Raps) Longer, longer, longer, drop, then you have a
= WENCKEBACH!
(Heart Blocks Raps) If some Ps don’t get through, then you have a:
= MOBITZ II!
(Heart Blocks Raps) If Ps and Qs don’t agree, then you have a:
= THIRD DEGREE!
Systematic approach
- rate, 2. rhythm, 3. P waves, 4. PRI, 5. QRS
Re-entry loops
= stuck in nascar loop in a chambers pathway causing SVT / no P waves
WPW) Orthodromic loop;
Antidromic loop:
Treatmeats:
= Clockwise reentry w/ narrow complex
= Counterclockwise reentry w/ wide QRS
= procainamide 1a Na blocker, (if no procain) sedate & cardiovert) cardioversion
- (Accelerated Junctional) Know by:
- Definer:
- Symptomology:
- Treatment:
1= “Baby Tachy” faster than 60 not faster than 100
2= 61-100BPM, (from SNS & AV firing), Regular rhythm, AV P waves
3= usually does not cause a PT to have symptoms
4= Be a investigator ,History/Physical ,O2 as needed , 15 Lead ECG
- (Accelerated Junctional) Know by:
- Definer:
1= “Baby Tachy” faster than 60 not faster than 100
2= 61-100BPM, (from SNS & AV firing), Regular rhythm, AV P waves
- (Junctional Tachycardia) Know by:
- Definer:
- Etiology:
- Rules:
- Symptomatology:
- Treatment:
1= “Tachy is Tachy”
2= >100BPM, AV P waves
3= +SNS response w/ AV site & Result of AV ischemia (rarely>150)
4= >100, AV P waves & Pacing, N. QRS, ~reg/rhythm, if PRI ~<.12secs
5= usually PT doesn’t has symptoms
6= invest/, Hx, O2 PRN, 15 Lead, monitor for other arrhythmias
- (Junctional Tachycardia) Know by:
- Definer:
1= “Tachy is Tachy”
2= >100BPM, AV P waves
Atrioventricular (AV) block:
Electrical impulse is slowed or blocked as it passes through AV node
AV block possible causes:
MI, (inferior RCA) AV ischemia and/or necrosis, Degenerative disease of conductive system, Drug toxicity (particularly digitalis)
Heart Blocks 4 Different Types) A.
B.
C.
D.
1st-Degree AV Block> add to rhythm “w/”
2nd-Degree Type I AV block (Mobitz I, or Wenckebach) rhythm
2nd-Degree Type 2 AV block (Mobitz 2 or intranodal)”2:1 block” rhythm
3rd-Degree AV Block aka “complete heart block” rhythm
2nd-Degree Type I AV block) names
Mobitz 1 or Wenckebach
Wenckebach) Sir name
2nd-Degree Type I AV block
2nd-Degree Type 2 AV block) names:
Mobitz 2 or intranodal AKA “2:1 block” rhythm
Intranodal/Mobitz 2) Sir name
2nd-Degree Type 2 AV block
- (1st Degree AV Block) know:
- Definer:
- Rap:
- Rules:
- Etiology:
- Cause:
- Symptoms:
- Treat:
1= “add to any rhythm” “gandolf slowly opening door(PRI)”
2= PRI: >than 0.20 seconds for every PRI & P-P cadence
3= “If the R is far from the P, then you have a FIRST DEGREE!”
4= BPM & rhythm is underlying rhythm, P Waves: Norm/ shape, PRI >0.20secs Pace-Site: SA or atria, QRS: Usually normal
5= Delay in AV node rather than actual block (increases PRI), Not a rhythm but a condition w/in another rhythm
6= Ischemia @ AV junction, MI/@AV, getting old, arteriosclerosis
7= PT usually don’t have symptoms
8= investigate, History/Physical, O2 as needed, 15 Lead ECG
- (1st Degree AV Block) know:
- Definer:
1= “add to any rhythm” “gandolf slowly opening door(PRI)”
2= PRI: >than 0.20 seconds for every PRI & P-P cadence
- (2nd Degree Type I) AKA & Know:
- Definer:
- Rap:
- Rules:
- Symptomology:
- Treatment:
1= “Morbitz 1”/“Wenckebach” rhythm & “AV turning off to fully down”
2= progressive longing PRI till drops beat then resets/starts over
3= “Longer, longer, longer, drop, then you have a WENCKEBACH!”
4= Rate: Variable, QRS rate will be slower than atrial rate Rhythm: Irregular P Waves: Normal but some P waves don’t have a QRS PRI: longing ‘til a QRS dropped Pace-Site: SA node or atria QRS: ~normal
5= Can compromise cardiac output, Syncope, angina, Commonly MI
6= O2 as needed, 15 Lead ECG, If signs of poor perfusion, prep for transcutaneous pacing only if brady.
- (2nd Degree Type I) AKA & Know:
- Definer:
1= “Morbitz 1”/“Wenckebach” rhythm & “AV turning off to fully down”
2= progressive longing PRI till drops beat then resets/starts over
- (2nd Degree Type II) AKA & know:
- Definer:
- Rap:
- Rules:
- Etiology:
- Symptomology:
- Treatment:
1= “Mobitz 2/Intranodal” & “random extra Ps”
2= some P’s w/o QRS & same PRI/No longing before drop beat
3= “If some Ps don’t get through, then you have a MOBITZ II!”
4= Rate P’s unaffected; QRS rate usually brady Ir/Reg/ Rhythm, P’s WNL but some w/o QRS, PRI Constant for conducted beats, Pace-Site SA node or atria, QRS WNL or wide
5= Intermittent block, Ps not conducted to ventricles via AV (Associate w/ acute MI & septal necrosis)“2-1 block” = 2 P’s before QRS
6= May comp/ CO, syncope, angina; May dev/ into complete AV-block
7= PT condition based: If signs of poor perfusion prep for trans/pacing
- (2nd Degree Type II) AKA & know:
- Definer:
1= “Mobitz 2/Intranodal” & “random extra Ps”
2= some P’s w/o QRS & same PRI/No longing before drop beat
- (3rd Degree AV Block) AKA & know
- Definer:
- Rap:
- Rules:
- Etiology:
- Symptomology:
- Treatment:
1= “Complete AV-Block/dissociation” (always TCPP on) “gandalf died”
2= No relations w/ Ps & QRSs & no same PRI (top & bottom dif)
3= “If Ps and Qs don’t agree, then you have a THIRD DEGREE!”
4= P’s unaffected; QRS rate usually brady Rhythm: Ps & QRSs WNL but don’t coincide w/ other Ps: Norm w/ no relation w/ QRS Pace-Site: SA node or atria for P’s; AV node or Ventricle for QRS, QRS WNL or wide
5= NO conduction w/in atria & ventricles, Complete electrical block @/ below AV node Acute MI, Digoxin toxicity, Degen/ of conductive system
6=May severely compromise CO
7= If signs of poor perfusion, prep for immediate TCP
- (3rd Degree AV Block) AKA & know
- Definer:
1= “Complete AV-Block/dissociation” (always TCPP on) “gandalf died”
2= No relations w/ Ps & QRSs & no same PRI (top & bottom dif)
only condition A-Fib has cadence:
Afib w/ 3rd degree In rhythm “Gandalf dead so Atriums & Ventricles doing own thing
(Adenosine) class:
Dynamics:
= Misc antiarrhythmic binds to adenosine A1 receptors causes efflux of K & inhibits Ca influx (in autoarhythmic cells)
= Causes hyperpolarization of autorhythmic cells (SA/AV node)
Slows AV conduction w/ very short half-life
(Adenosine) indications:
contraindications
= 1st for stable narrow complex SVT, Regular & monomorphic wide-complex Tcardia thought from a reentry SVT (SVT w/ BBB)
= Torsades de pointes, Poison/drug-Tcardia, 2nd or 3rd AVB, WPW,DOESNT CONVERT A-FIB/FLUTTER
(Adenosine) Effects:
Dose:
admin notes:
= periods of sinus Bcardia/asystole & ventricular ectopy after admin
= 1st dose 6mg rapid IV/IO push followed w/ rapid flush &2nd dose 12mg also rapid push & flush
= rapid push followed by rapid flush 20mL fluid best accomplished w/ 3-way stopcock & 1/2 initial dose in PTs receiving dipyridamole or carbamazepine, heart transplant, or if given by central venous access
(Aspirin) Class:
Dynamics:
= NSAID & COX inhibiter
= Blocks cyclooxygenase (enzyme that’s basically alarm bell for body)
COX acts upon Arachidonic Acid which in turn gen/s Thromboxane A2, a compound that reg/s the activation of platelets to form a clot
(Aspirin) indications:
Contraindications:
= Cardiac S/S w/ ischemia etiology
= common allergy, Bronchospasm, Angiodema
(Aspirin) effects:
Avoid:
dose:
=Can cause bromchoconstriction in ~10% asthmatic PTs, N/V, upset GI
= enteric-coated Aspirin when admin/ing to PT w/ cardiac S/S
= 160-325mg PO of non-entric coated ASA
(Atropine) class:
Dynamics:
= parasympatholytic
= selectively blocks muscarinic receptors inhibiting the parasympathetic NS “Vagus N. Blocker”- letting sympathetic take over
(Atropine) indications:
Contraindications:
Avoid:
= 1st med/ for symptomatic sinus Bcardia, Maybe beneficial AV block, Organophosphate poisoning (large dose r/q) hypothermic Bcardia
= Allergic to drug, Use w/ extreme caution w/ myocardial ischemia
= causes increased myocardial O2 demand so caution w/ Hblock & Doses <0.5mg may result in paradoxical slowing of the heart
May not be effective for infranodal blocks- be prepared to pace
(Atropine) Adverse effects:
Bradycardia (w/ or w/o ACS) Dosage:
severe clinical conditions dosage:
organophosphate poisoning dosage:
= Blurred vision, Dry mouth, Dilated pupils, Confusion
=1 mg IV push every 3-5mins as needed (0.04mg/Kg (total 3mg)
=1 mg IVP every 3 mins
= 2-4mg (or higher) IVP
(Calcium Chloride) indications:
Contraindications:
= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD
(Calcium Chloride) effects:
Dose:
Hypotension following admin/ Diltiazem:
= Bcardia w/ rapid injection, May produce severe coronary spasm & asystole, Burning sensation @ site of admin/, PERCIPITATE w/ Na-Bicarb
= 0.5-1gram slow IV over 3-5mins
= 250-500mg
(Calcium Chloride) indications:
Contraindications:
= Hyper/o/kalemia, Treatment of affects by Ca Chanel blocker OD, HypoBP 2ndary to admin/ of Diltiazem
= cardiac arrest (Unless hyperkalemia suspected)PTs taking Digoxin w/ suspected calcium Chanel blocker OD
(Diltiazem/Cardizem)class:
pharmacodynamics:
= IV (4) antiarrhythmic Ca channel blocker
= slows auto arrhythmic cells AP in heart atriums by blocking Ca channels
(Diltiazem/Cardizem)effects:
1st dose:
2nd dose:
= HypoBP, Pos/ CHF if used w/ beta-blockers , N/V/D, Dizziness, H/A
= 0.25mg/kg w/ max dose of 20mg
= 0.35 mg/kg w/ max dose of 25mg
(Diltiazem/Cardizem)indi/s:
Contraindications:
= 1st med for AFib/Flutter w/ RVR (>150bpm), 2nd med for SVT refractory to Adenosine
= hypoBP, CHF/cardio/shock, Wide-complex Tcardia, WPW, Hypersensitivity
(Labetalol) class:
pharmacodynamics:
= beta-blocker
= Blocks adrenergic stim/ on B-receptors, causing a slowing of HR
(Procainamide) max dose:
Recurrent VF/VT:
Urgent situations:
Maintenance Infusion:
= (max total dose: 17mg/kg)
= 20mg/min (max total dose: 17mg/kg)
= up to 50mg/min may admin/ to total dose (max 17mg/kg)
= 1-4mg/min
(Labetalol) Indications:
Contraindications:
Do not administer to PTs w/ STEMI if following present:
= 2nd med/ for SVT after admin/ Adenosine, A-Fib/Flutter w/ RVR Reduce myocardial ischemia in AMI PTs w/ +HRs, Antihypertensive
= Increased risk of cardiogenic shock Hypotension Bradycardia
= signs of heart failure Low cardiac output
(Labetalol) Adverse Effects:
Max dose:
Adult Dose:
= admin/ after IV Ca-channel blockers can cause severe hypotension, Bcardia, heart blocks & CHF
= 150mg
= 10 mg IV/O push 1-2 mins & May repeat every 10 mins to max dose
(Procainamide)class:
Dynamics:
= 1a antiarrhythmic
= Blocks Na channels in cardiac cells which causes depolarization to slow & decrease automaticity
(Procainamide) indications:
Contra:
=V-Tach w/ pulse, Pre-excitation rhythms (WPW)
=Shouldn’t admin to PTs received IV Ca channel blocker
Procainamide)effect:
4 ending points:
= Drowsy, Slurred speech, Confusion, Seizures, HypoBP
= 1. Termination of rhythm, 2. HypoBP, 3. Widening QRS>50%, 4. Meet the max total dose
Natural pacemaker of the heart is:
If SA Node failed to initiate a impulse, what is 1st back-up firing site?
If both SA & AV fails what is last firing site:
= SA node
= AV node
= Purjunkie
Ejection Fraction (EF):
<45% usually indicates:
<30%:
= Ratio of blood pumped from the ventricle to the amount remaining @ the end of diastole/ %of blood pumped out from ventricle (60-70%)
=<45% usually indicates in or going to CHF
=<30% in CHF & chronic cardiac crip on oxy
!!Poiseuille’s law:
Example:
= vessel w/ relative radius of 1 would transport 1mL per min at BP difference of 100mmHg. Keep pressure constant
= Less blood = vaso-press
Which coronary artery feeds the inferior wall of the heart?
Right Coronary Artery (RCA)
Which coronary artery feeds the left lateral wall of the heart?
Left Circumflex (LCX)
A blockage of which of the following would result in the entire left ventricle not receiving blood supply?
Left Main Coronary Artery (LMCA)
Precordial “chest” leads:
V1 location:
V2 location:
V3 location:
V4 location:
V5 location:
V6 location:
V ”5” 8 location:
V ”6” 9 location:
=
= V1: 4th ICS R of sternum
= V2: 4th ICS L of sternum
= V3: ½ in between
= V4: 5th ICS mid-clavicularly
= V5: 5th ICS anter auxillary
= V6: mid auxillary
= V ”5” 8: 5th ICS mid scapular
= V ”6” 9: ½ between spine & midscapular
Double hump P wave morphology:
Sharp P morph/:
= atrium ballooning & way dif
= Pulmonale from right atrium pulmonary
(P wave) Limb leads amplitude:
Precordial “chest” leads amplitude:
= <2.5mm in limb leads Avl (2.5mV)
= <1.5mm in precordial (1.5mV)
(T wave) Limb leads Amplitude:
Precordial “chest” leads amplitude:
= <5mm in LL
= <10mm in precordial
1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:
1= Lead I & aVL= LA
2= Lead 1, aVL, V5 & V6: views LCX & LAD
3= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
4= V1 & V2: Along sternal borders blockages from LAD commonly
5= V3 & V4: left anterior wall : LAD & LMCA blocks
Class IV Antiarrhythmic of Vaughan-Williams Class is:
Class I Antiarrhythmic of Vaughan-Williams Class is:
Class III Antiarrhythmic of Vaughan-Williams Class is:
Class II Antiarrhythmic of Vaughan-Williams Class is:
= Calcium channel blocker
= Sodium channel blocker
= Potassium channel blocker
= Beta-Blocker
When obtaining a 12 lead ECG, where do you place V2?
When obtaining a 12 lead ECG, where do you place V5?
When obtaining a 12 lead ECG, where do you place V6?
When obtaining a 12 lead ECG, where do you place V3?
When obtaining a 12 lead ECG, where do you place V1?
When obtaining a 12 lead ECG, where do you place V4?
When obtaining a 15 lead ECG, where do you place V4R?
= 4th ICS just left of Sternum
= Left 5th ICS anterior of auxiliary
= 5th ICS midaxillary
= ½ in between V2 & V4
= Right of Sternum 4th ICS
= 5th ICS left Midclavicular
= Right ICS midclavicular
Widowmaker :
clot in left coronary artery wiping out L side
Ectopic
Not the normal
Leads V1 and V2 look at what part of the heart?
Septal
Leads V3 and V4 look at what part of the heart?
Anterior
Leads II, III and aVF look at what part of the heart?
Inferior
An ECG rhythm that presents with a rate of 70 beats per minute, has an irregular cadence, a normal looking P wave but the PRI progressively gets longer until a QRS complex is dropped is classified as a:
Wenckebach
Initial dose of Adenosine for SVT:
2nd dose of Adenosine for SVT:
= 6 mg given rapid IV push, followed with a 20 mL flush.
= 12 mg given rapid IV push, followed with a 20 mL flush.
Premature ectopic beat presents w/ a inverted P wave & narrow QRS:
Premature ectopic beat presents w/ an upright P wave & narrow QRS:
= Premature Junctional Contraction (PJC)
= Premature Atrial Contraction (PAC)
An ECG rhythm that presents with P waves and QRS complexes that don’t appear to coincide with each other is classified as a:
3rd Degree AV block
The upward slurring of the isoelectric line after the P wave up into the QRS complex that is associated with Wolff Parkinson White Syndrome (WPW) is known as the:
The accessory pathway associated with Wolff Parkinson White Syndrome (WPW) is known as the:
= Delta wave
= Bundle of Kent
Typically, we don’t attempt to control the rate of Atrial Fibrillation unless it is
above 150 per minute and the patient is presenting with signs and symptoms related to the rhythm.
A junctional escape rhythm would present with a ventricular rate between
An accelerated junctional escape rhythm would present with a ventricular rate between
= 40 & 60 beats per minute.
= 61 & 100 beats per minute.
Initial dose of Diltiazem for the control of Atrial-Fib w/ RVR is:
ECG rhythm that presents w/ a ventricular rate of 170-190 beats per minute, has a totally irregular cadence, has no discernible P waves, and has narrow QRS complexes is classified as:
= 0.25 mg/kg with a max dose of 20 mg.
= A-Fib with RVR
ECG rhythm presents w/ rate of 30-50BPM, totally irregular cadence, has no discernible P waves, narrow QRSs is classified as:
A-Fib with SVR
An ECG rhythm that presents with a ventricular rate of 80-100 beats per minute, has a totally irregular cadence, has no discernible P waves, and has narrow QRS complexes is classified as:
Controlled A-Fib w/ RVR
Supraventricular tachycardia will have a heart rate of:
ECG presents w/ rate of 200BPM, reg/ cadence, no visible P waves, narrow QRSs is classified as:
= at least 150 beats per minute.
= Supraventricular Tachycardia
if the R is far from the P, then you have a:
1st Degree
ECG rhythm presents w/ rate 80 BPM, reg/ cadence, norm/ shaped P wave, a prolonged but constant PRI, & norm/ QRS is classified as as:
Sinus with 1st Degree
If SA node for some reason stops firing, what should be 1st back-up firing system?
AV Node
A junctional tachycardia rhythm would present with a ventricular rate
greater than 80 beats per minute.
A junctional bradycardia rhythm would present with a ventricular rate
less than 40 beats per minute.
if some Ps don’t get through, then you have a:
Mobitz 2
ECG rhythm presents w/ a ventricular rate of 80 BPM, reg/ cadence, saw-tooth waves in place of P waves, & narrow QRSs is classified as:
Atrial Flutter
Sinus bradycardia rhythm would present w/ a ventricular rate less than:
Sinus tachycardia rhythm would present with a ventricular rate:
= 60 beats per minute
= greater than 100 beats per minute
ECG rhythm presents w/ rate 110 BPM, slightly irregular cadence, & P waves that have three or more different morphologies is classified as:
Multifocal Atrial Tachycardia
ECG rhythm presents w/ a rate of 40BPM, reg/ cadence, normal looking Ps, normal PRI for the P waves that have a QRS following, but has some P waves that don’t have a QRS after it is classified as a:
2nd Degree Type II / Mobitz 2
if Ps and Qs don’t agree, then you have a
3rd degree
(Verapamil) class:
pharmacodynamics:
= IV antiarrhythmic Ca channel blocker
= Slows AP of autorhythmic cells in heart by blocking Ca channels
(Verapamil) indications:
Contraindications:
= 2nd med for A-Fib/Flutter w/ RVR, May use as alterative med (after adenosine), narrow QRS complex Tcardia w/ preserved LV function
= HypoBP (SBP<90), CHF/cardio/ shock, Wide-complex Tcardia, WPW
Hypersensitivity to med
(Verapamil)1.May cause:
2. Effects:
3. Max total dose:
4. 1st dose:
5. 2nd dose:
1.= more profound hypotension response than that of Diltiazem
2.= Severe CHF may result if used w/ beta-blocker, N/V/D, Dizziness, H/A
3.= 20mg
4.=2.5-5mg IV/O bolus 2-3min
5.= 5-10mg over 2-3 mins
