MARK KLIMEK LECTURE 3 CARDIAC

MARK KLIMEK LECTURE #3 – CARDIAC

Calcium Channel Blockers are like Valium for your heart (calms your heart down) CCB’s are negative inotropics, negative dromotropics, and negative chromotropics. Weaken, slow down, and depress the heart. Cardiac depressant.

They treat: A, A-A, and A-A-A

 Anti-hypertensive – relaxes heart and blood vessels – BP goes down  Anti-Angina – relaxes the heart – decreases oxygen demand – pain goes away  Anti-Atrial-Arrhythmia= it treats everything atrial related = treats supra ventricular tachycardia (supra means above, above the ventricle is the atrial).

Side effects: Headache & Hypotension

Headache (vasodilation in the brain) Hypotension (relaxes the heart and the blood vessels) Monitor BP intermittently. If systolic is <100, hold!

Names of CCB’s:

 Names ending in “dipine” (You're dipping in the calcium channel) amlodipine, felodipine, isradipine, nicardipine, nifedipine, nisoldipine  Verapamil, Diltiazem, Cardizem [Cardizem = Continuous IV drip]  For drip, monitor BP continuously. If systolic BP is 98 titrate it down. This study source was downloaded by 100000857336479 from CourseHero.com on 03-13-2023 20:51:27 GMT -05:00 https://www.coursehero.com/collection/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/

Cardiac Arrhythmias (#03 – time13:33)

• Normal sinus rhythm - Peaks of p waves are evenly spaced
• V-fib - Chaotic squiggly line. No pattern
• V-tach - Sharp peaks & jags. There's a pattern
• Asystole - Flat line
• Atrial Flutter
• Atrial Fibrillation
• PVCs This study source was downloaded by 100000857336479 from CourseHero.com on 03-13-2023 20:51:27 GMT -05:00

https://www.coursehero.com/collection/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/

Terminologies (time 19:50)

 P wave- Answer will always be atrial  Lack of a P wave- is ventricular  QRS depolarization- Answer will always be ventricular Six rhythms most tested on NCLEX

• Asystole – “a lack of QRS” depolarization’s (a straight line); NO ventricular action at all
• Atrial flutter – “SAW TOOTH”

Rapid P-wave depolarization’s in a saw-tooth (flutter) Fibrillation - always described with the word CHAOTIC

• Atrial fibrillation

 Chaotic P-wave depolarization’s (lacks any discernable pattern)

• Ventricular fibrillation

 Chaotic QRS depolarization Tachycardia – always describe with the word BIZARRE

• Ventricular tachycardia

 Wide, bizarre QRS’s  Tachy is always discernable repeating pattern

• Premature ventricular contractions (PVCs)

 Periodic wide, bizarre QRS’s – short run of VTachs  Generally are low to moderate priority. unless everyone else has a normal rhythm

 Be concerned, if:

• More than 6 PVCs per minute - if there is any change in rhythm  Check Pulse and BP
• If there are 6 PVCs in a row
• PVC falls of T-wave of previous beat

Low Priority:

 Premature ventricular contraction (PVC)  A bunch of PVC’s is like a short run of V-Tach

Moderate Priority:

 If more than 6 PVC’s in a minute, or  if there are more than 6 PVCs row, or  if the PVC falls on the T wave of the previous beat.(R on T phenomenon)  They are NEVER a high priority!High Priority

Lethal / Life Threatening: Kills you in 8 mins or less.

Prioritize!! – THERE IS NO CARDIAC OUTPUT  Asystole- No pulse  V-fib- No pulse

Potentially Life Threatening:

 V-Tach- Patient has a pulse – still have cardiac output This study source was downloaded by 100000857336479 from CourseHero.com on 03-13-2023 20:51:27 GMT -05:00 https://www.coursehero.com/collection/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/

Treatment: (time 29:20) (Ventricular) PVC’s & V-Tach  Use Amiodarone or Lidocaine (Atrial) Supra Ventricular Tachycardia (SVT) Atrial FlutterABCD + Heparin Atrial Fibrillation ABCD + heparin  Use ABCD

Adenocard (Adenosine):

 Push in less than 8 secs  Don't worry about Asystole (about 30secs if not, then meds not working!)  When it comes to IV push, when you don’t know go slow Beta blockers (ending in “lol”)  Just like CCB’s, same treatment, same side effects  be careful of patients with asthma – some are bronchoconstrictors Calcium channel blockers  Better for asthmatics (same effect with Beta Blockers) Digoxin/Digitalis (Lanoxin)  Last resort because of possible digoxin toxicity V-fib  D-fib  D-fib – defibrillation + Epinephrine + Amiodarone AsystolE – needs positive ino/dromo/chromo  Epinephrine (GIVE FIRST)  Atropine (Give only if Epi didn’t work) Treats A A-A A-A- A- This study source was downloaded by 100000857336479 from CourseHero.com on 03-13-2023 20:51:27 GMT -05:00 https://www.coursehero.com/collection/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/