Antidysrhythmics and anticoagulants Flashcards
What makes long QT syndrome dangerous?
they can convert into a potentially fatal ventricular tachycardia called torsades de pointes
What test can detect dysrhthmias?
Electrocardiogram (ECG)– the only test that directly assesses the conduction of the heart
there are other tests that determine cause but ECG lets you know there is an issue
What type of condition is a risk factors for dysrhythmias?
-any condition that alters or interferes with electrical signals following the usual pathways through the myocardium or disruptions in homeostasis that increase or decrease the “excitability” of the myocardium
What are some diagnostics that help to discover the CAUSE of dysrhythmia?
-imaging to assess changes in morphology and functioning of the myocardium– echocardiogram
-imaging of the blood supply to the myocardium– angiogram
-blood tests for metabolic imbalances
What are some symptoms of dysrhythmia?
-palpitations
-dizziness
-chest pain
What findings support myocardial ischemia? Decreased CO?
Ischemia
-chest pain
-pressure
-shortness of breath
-tachycardia
-sweating
-nausea
-atypical signs can be subtle so keep an eye for them
CO
-cardiogenic shock
-really low BP
-mean arterial pressure of about 65 or less shows decreased or no perfusion
-clammy
What is the first line of treatment for Afib?
beta blockers (cardio-selective)
ex. atenolol, metoprolol and bisoprolol
What does hemostasis mean?
the stopping of blood flow– is an essential mechanism protecting the body from both external and internal injury
Where are thromboplastin and fibrinogen (clotting factor proteins) made?
in the liver– they constantly circulate through the blood in an active form
vitamin K is required for the liver to make four of the clotting factors
Disorder to which organ will lead to abnormal coagulation?
serious liver disorders
Define fibrinolysis
the process of clot removal– initiated 24-48 hours after the clot is formed and continues until the clot is dissolved
When should you test or monitor PTT?
before giving heparin and ONLY if the heparin is through IV, NOT for subcut
What is D-dimer?
a protein fragment produced during abnormal blood clotting
What is the therapeutic range for INR?
2-3
What is the US test for?
checking the leg veins for diagnosing DVT
When are direct oral anticoagulants (DOAC) contraindicated?
-heart valve disease/replacement
-significant renal impairment (CKD stage 3 or greater)
these pts will get warfarin for an oral anticoagulant
What are the most common indications for long-term anticoagulation?
-a-fib
-cardiac valvular disorders or artificial valves
-recurrent DVT
What does the acronym CHADS-65 stand for?
A means of predicting the likelihood that a patient in atrial fibrillation will have a stroke. CHADS is a mnemonic for c(ongestive) heart failure; h(ypertension), a(ge) over 75 years, d(iabetes) mellitus, and a previous history of s(troke) (or transient ischemic attack
Describe Beta blockers
competes for receptors of catecholamine at the B1-receptor sites in the heart (it blocks these receptors), resulting in decreased heart rate, cardiac contractility, and CO
Indications– antihypertensive, angina (post-MI), heart rate control
ex. metoprolol, atenolol and bisoprolol