Medical - Surgical Pearls

CAD, where arteries narrow from plaques which partially or totally occlude the coronary artery vasculature

The coronary arteries develop a thrombus or blood clot formation at a site of ruptured or narrow plaque which leads to acute symptoms of CP (angina) , hypotension , and dysfunction of the heart . Treatment is directed at reopening the artery and medical or surgical stabilization .

Gender ( males, higher risk), family history of heart disease , and increasing age .

Diet( lower fat , salt), hypertension, diabetes, cigarette smoking , sedentary lifestyle , high levels of triglycerides , and low- density lipoprotein, and stress level ( type A personality carries higher risk

Cigarette smoking. A med-surg nurse , who convinces and assists their patients to stop smoking , does a tremendous service for the patient and their family

Interscapular back pain. Classically, is a sharp , tearing , severe pain

Hypotension. Other side effects include : myocardial depression , QRS/QT prolongation , V-fib-and Torsade de pointes

Drowsiness, nausea, vertigo, confusion , ataxia, tinnitus , muscle twitching , respiratory depression , and psychosis . ECG changes may be seen also

Potent inotrope with some vasodilation activity , used when heart failure is not accompanied by severe hypotension , Dobutamine decreases afterload and increases contractility

Vasoconstrictor and positive inotrope , is used to increase cardiac output , especially of Shock is present

Hypertension, coronary artery disease , vascular disease , sudden death ( arrhythmia ), or hyperlipidemia

Heart rate greater than 100 beats per minute and every QRS complex follows a P wave

Heart rate less than 60 beats per minute and every QRS complex follows a P wave

Initiate A-V nodal blockade with B- adrenergic or calcium channel blockers or with digoxin. If necessary , in a stable patient , attempt chemical cardioversion with a class IA agents such as procainamide or quinidine after digitalization .if such treatment fails, or if patient is unstable and requires immediate electrocardioversion, do so with 25-50J. Sedation should be considered prior to electrical cardioversion .

Hypertension, rheumatic heart disease, pneumonia , thyrotoxicosis and ischemic heart disease are common causes . Pericarditis , ETOH intoxication , PE, CHF, and COPD are other causes

If patient is stable, then control a fast ventricular rate with diltiazem bolus and/or IV infusion . Consider digitalis , and if indicated , convert with procainamide , quinidine , or verapamil. Synchronized cardioversion at 100-200 J in an unstable patient requiring cardioversion . In a stable patient with afib or unclear duration , anticoagulation for 2-3 weeks should be considered prior to chemical or electrical cardioversion in order to decrease the chance of an embolic stroke or other embolic problem .

SVT May be due to digitalis toxicity (25% of digitalis induced arrhythmia ), pericarditis , MI, COPD, preexcitation syndromes , mitral valve prolapse , rheumatic heart disease , pneumonia , drug and alcohol abuse