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Mark Klimek Lecture Notes

Lecture 3: Calcium Channel Blockers, Arrhythmias,

Chest tubes, Congenital heart defects

Calcium Channel Blockers • calcium channel blockers are like valium for your heart • calms your heart • given when heart is tachycardic, pt is having tacharrhythmias, had a heart attack and need to rest heart • never give to stimulate heart • negative inotropic, chronotropic and dromotropic- its like valium for your heart- relax your heart and calm it down

Positive Chrontropes:

• strengthen • speed up and stimulate the heart • they are stimulants

Negatives • cardiac depressant • weaken • slow down and depress the heart

What do Calcium channel Blockers they treat?

• Antihypertensives- relax your heart blood vessels and blood pressure goes

down AA) Antiangina- relax your heart, uses less oxygen, and decreases oxygen demand because it relaxes the heart- worst thing that can happen to person with angina is if their heart speeds up so we want to slow it down AAA) Anti Atrial Arrhythmias- (will not treat ventricular tachycardia) treats atrial flutter, atrial fibrillation, premature atrial contractions

TRICK: supraventricular tachycardia- supra means above, and the atria is above

the ventricle.

Side effects?**think H&H

• headache – vessels dilate in the brain causing migraine
• hypotension- relaxes heart and blood vessels

*headache is great choice for SATA most times 1 / 2

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NAMES of Calcium Channel Blockers:

• Anything ending in dipine

Example: Amlodipine

• Think “Dipin in the calcium channel” (NOT PINE BECAUSE MANY DRUGS END IN PINE BUT CALCIUM CHANNEL BLOCKERS ALWAYS HAVE DIPIN in the word)

Calcium channels you MUST KNOW BY NAME

VERAPAMIL

CARDIZEM - Continuous IV Drip

***Vital signs needed to measured before giving a calcium channel blocker, ex. Blood pressure because pt will be at risk for hypotension

Parameters for Calcium Channel Blockers:

• hold the calcium channel blocker if the systolic is under 100, must monitor the blood pressure continuously while on cardizem drip and if it was 98/52- slow down the drip and measure BP again to keep the systolic over 100

Cardiac Arrhythmias • Know how to interpret rhythm strips

• Know 4 by site:

• Normal sinus rhythm – p wave, qrs and t wave for every single complex,

and peaks of QRS complex are evenly spaced

• V fib- chaotic squiggly line, no pattern
• Ventricular tachycardia – sharp peaks and jaggers with pattern
• Asystole -down and out, crash and burn time, flat line

Important terminology

• QRS depolarization- ventricular, rule out anything that says atrial
• P wave- refers to anything atrial and rule out ventricular
• 6 rhythms most tested on NCLEX

• Lack of QRS’s- no QRS- asystole (flat line) • Form of atrial- set P wave • Saw tooth- flutter- “I saw the teeth and my heart fluttered” • Chaotic- fibrillation • Bizzare always applies to tachycardia • Periodic bizzare wide QRS- pvc- SALVO of PVC’s =short run of Vtach, dr.’s don’t care as much for these, low priority

PVC’s are low priority but if there are more than 6 PVC’s in a minute or in a row, OR if PVC’s fall on the t wave of the previous beat (R on T phenomena) they become moderate but are never high- PVC’s are good after an MI or a heart attack because that means they are reprofusing.

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