TAILIEUCHUNG - Ebook Cardiology emergencies: Part 2

(BQ) Part 2 book "Cardiology emergencies" presents the following contents: Arrhythmias, valve disease, aortic dissection, pericardial disease, pulmonary vascular disease, systemic emboli, cardiac issues in pregnancy, adult congenital heart disease, perioperative care, cardiotoxic drug overdose, miscellaneous conditions,. | CHAPTER 8 Arrhythmias 88 Symptomatic AF with Mild-Moderate Hemodynamic Compromise Ventricular rate 100-150 bpm breathless and or mild hypotension. Consider other causes for hemodynamic compromise . sepsis. Onset 48 hours Heparin start at 80 units kg followed by 18 units kg h or low molecular weight heparin. Consider pharmacological cardioversion with amiodarone 150 mg IV bolus followed by 1 mg kg h drip over 6 hours followed by a mg min maintenance drip . If the patient has good hemodynamics no pulmonary edema and no known structural heart disease no previous ischemic heart disease or valve disease and a normal transthoracic echocardiogram an alternative to amiodarone is flecainide 150-300 mg po. Plan for electrical cardioversion 2-3 hours later if drug treatment fails. Synchronized DC shock under sedation using 200-360 J monophasic or 150-200 J biphasic energy. If immediate electrical cardioversion is not available start treatment with amiodarone while waiting. Onset 48 hours Heparin start at 80 units kg followed by 18 units kg h or low molecular weight heparin. Rate control with one of the following Digoxin 500 mcg in saline IV over 1 hour or 500 mcg orally at 12 hourly intervals for three doses then 125-250 mcg daily Beta-blocker . metoprolol 25-50 mg po bid Verapamil 40-80 mg po tid Diltiazem sustained release 60-120 mg po bid Amiodarone is poorly effective at rapidly controlling rate in AF when given orally but can be given as an IV bolus 150 mg followed by an IV drip at 1 mg kg h over 6 hours followed by mg kg h maintenance drip then switch to 400 mg po tid for 7 days . Digoxin and amiodarone are the drugs of choice for patients with known structural heart disease and impaired left ventricular function Use caution when combining diltiazem or verapamil with betablockers. Minimally Symptomatic AF with No Hemodynamic Compromise In this setting there is a ventricular rate of less than 100 bpm together with good perfusion. Onset 48 hours .

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• Cardiology emergencies
• Valve disease
• Aortic dissection
• Pericardial disease
• Pulmonary vascular disease
• Adult congenital heart disease
• Perioperative care
• Cardiotoxic drug overdose
• Chest pain
• Shortness of breath
• Cardiovascular collapse
• Acute coronary syndromes
• Acute heart failure
• Emergencies in cardiology
• Infective endocarditis
• Practical issues
• Practical procedures
• ECG recognition
• General considerations
• Cardiology subspecialty consult
• Approach to the cardiovascular consult
• Basic electrocardiography
• Evaluation of acute chest pain
• Cardiovascular emergencies