The ABCDEFG approach to Managing a patient
with Heart Disease:
A
Assessment of
Cardiovascular Risk – modifiable and non-modifiable Risk factors and ACLS H and
Ts – History and Physical Exam; Arterial Blood Gases (ABGs); Air (O2); Anti-Platelet agents – Aspirin – to be chewed to bypass First Pass Metabolism by liver and
instantaneous action within seconds –
shown to decrease mortality, Plavix (Clopidogrel); ACE inhibitors – prils (oral) –prilat (IV) – shown to decrease mortality and promote ventricular wall remodeling;
ARBs (-sartans); Anticoagulants –
Start with LMWH (Enoxaparin action is monitored with aPTT and action is
reversed with Protamine Sulfate) and Warfarin then discontinue Enoxaparin after
5-7 days – monitor PT/INR reverse with Vitamin K or Pradaxa (dabigatran
etexilate – no monitoring needed) for
AF to prevent Stroke, Analgesics for pain – narcotics; Anti-arrhythmics – (Class 1,2,3,4 – So,Be,Po, Ca – MOA – Sodium
channel, Beta blockers, Potassium channel, Calcium channel blockers
respectively) ACLS 2010 removed ATROPINE from management of Asystole/PEA, Antibiotics
for IE (Infective Endocarditis – most commonly Left sided due to high
pressure - suspect IV drug abuse in Right Sided IE – tricuspid – involvement due
to S. aureus send cultures before
starting Broad spectrum Antibiotics – may be culture positive or negative); Alteplase (Thrombolytic use beneficial within 6 hours of start of symptoms); Angiography or cardiac
catheterization with or without Balloon Angioplasty
and Stenting (drug eluded).
B
Beta-Blockers – Beta-1
selective bisoprolol (Zebeta), carvedilol (Coreg), metoprolol (Lopressor) –
have been shown to reduce mortality; elevate the leg end of the Bed after a MI; Blood Culture and Serology and enzymes– before starting Antibiotics for IE and
to find the cause of cardiomyopathy.
C
Calcium Channel
Blockers (CCBs) – -dipines, diltiazem and verapamil - amlodipine (Norvasc),
diltiazem (Cardizem), felodipine, nifedipine (Procardia), nisoldipine (Sular),
verapamil (Calan) are used for diastolic
heart failure(when your heart has a hard time filling with blood) and to
lower Blood Pressure. NOT used for
Systolic Heart Failure (inability of the week ventricles to pump out blood); Chest X-Ray (CXR) to detect pulmonary
cause (Cor-Pulmonale – Right sided Heart Failure secondary to lung disease),
Trauma – mediastinal widening, congenital heart disease – Boot shaped heart in
TOF, Egg on a string appearance in TGA, Cardiomegaly (Cardio Thoracic ratio
> 50% on a CXR PA view); Cardiac
Enzymes – GPBB (Glycogen Phosphorylase isoenzyme BB – elevated 1-3 hours
after ischemia and peak in 7 hours),
Troponin T and I (released within 2-4 hours after ischemia, peak in 12
hours and persist up to 7 days), Creatine
Kinase – MB (CK-MB is relatively specific without skeletal muscle damage
and levels peak in 10-24 hours and persists for 2-3 days; Coronary Artery Bypass Grafting using Internal Mammary Artery
Graft, Radial Artery or Saphenous veins
(CABG types – traditional CABG using heart-lung bypass machine, CABG done on a beating heart - Off-pump CABG, and the newer Minimally
Invasive Direct CAB (MIDCAB)surgery performed without cutting ribs or
sternum; Cholesterol-Lowering drugs – Statins
are FIRST LINE therapy (also known as HMG CoA reductase inhibitors – major side effects include myopathy
including Rhabdomyolysis and Hepatotoxicity – elevated liver enzymes and
latest addition is early CATARACTS) – mainly lower LDL (BAD) cholesterol,
also modestly lower Triglycerides (TGs) and raise HDL (GOOD) cholesterol – atorvastatin
(Lipitor), Simvastatin (Zocor),
Selective Cholesterol Absorption Inhibitors – ezetimibe (Zetia), Other
therapies for dyslipidemias include Resins also called Bile acid
Sequestrant or Bile acid binding Drugs, Fibrates (Fibric acid derivatives), and Niacin (Nicotinic Acid); Cardiac Monitor in the ER – Telemetry Floor, 24 hour Holter monitoring or
event monitoring at home; Cardiac
Tamponade – diagnose clinically or using EKG and Echocardiogram or Chest CT/MRI–
perform ultrasound or CT guided Pericardiocentesis or Surgical pericardiectomy
(pericardial window); Cardiomyopathy – 5 types include Dilated cardiomyopathy, Hypertrophic cardiomyopathy,
Restrictive cardiomyopathy, Arrhythmogenic right ventricular dysplasia (ARVD),
and Unclassified type – find cause and treat accordingly;
DEF and G to be continued….Please check back
SOON!
Thank you
for updating your Medical Knowledge at Online Health Expert.
Sincerely,
Dr. Harish
Malik
Online Health Expert
