Cardio Flashcards
Normal QTc values
Males: <470 ms
Females: <480 ms
Drugs that induce QTc prolongation
-Antiarrhythmics (amiodarone, sotalol, dofetilide) - K+ channel blockers
-Antibiotics (fluoroquinolone, macrolides)
-Antipsychotics (1st gen)
-Antidepressants (citalopram, TCA)
-Antiemetics (zofran)
-Antifungals (-azole)
QTc clinical pearls
-Maintain K > 4 and Mg >2
->/= 500 ms or >/= 60 ms from baseline is QTc prlongation
Treatment for Tdp
-d/c offending agent
-Mg2+ push or infusion
-transcutaneous pacing
-isoproterenol infusion
skip last 2 if you are giving CPR
Drug induced HF causes
-Na and volume retention
-direct cardiotoxic drugs
-negative inotropy
HF due to Na+ and fluid retention
-NSAIDs
-steroids
-TZDs
avoid NSAIDs or steroids in HF patients if possible or minimize dose and duration
*avoid TZD use in patients with class 3 or 4 heart failure
HF due to cardiomyopathy
-chemo agents (anthracyclines)
-biologics (trastuzumab)
-alcohol (alc induced cardiomyopathy)
HF due to negative inotropy
-non dihydropyrine CCB (verapamil, diltiazem)
-beta blockers (avoid in HF exacerbation but can use in stable pts. may dec long term cardiomyopathy)
Dexrazoxane
use with doxorubicin to prevent anthracycline binding
dose limit for anthracycline
550 mg/m2 lifetime dose
Trastuzumab
-reversible
-do not have to completely avoid in HF but have to monitor frequently
-BBW: reductions in LVEF and HF development (monitor!)
-If EF declines use ACE/ARB, beta blcokers
Cocaine induced MI
-MI caused by vasospasm and vasoconstriction of CA
-Sympathomimetic crisis: cocaine inhibits reuptake of norepi leading to inc norepi conc and enhanced alpha 1 mediated vasoconstriction
(cocaine) chest pain treatment
-ASA
-benzos
(cocaine) persistent HTN treatment
-benzos
-IV notroglycerin
(cocaine) other acute ACS treatment
-pos avoid beta blockers
-proceed as normal
