Flecainide Considerations For
Total Page：16
File Type：pdf, Size：1020Kb
Load more
Recommended publications
-
Table 2. 2012 AGS Beers Criteria for Potentially
Table 2. 2012 AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Strength of Organ System/ Recommendat Quality of Recomm Therapeutic Category/Drug(s) Rationale ion Evidence endation References Anticholinergics (excludes TCAs) First-generation antihistamines Highly anticholinergic; Avoid Hydroxyzin Strong Agostini 2001 (as single agent or as part of clearance reduced with e and Boustani 2007 combination products) advanced age, and promethazi Guaiana 2010 Brompheniramine tolerance develops ne: high; Han 2001 Carbinoxamine when used as hypnotic; All others: Rudolph 2008 Chlorpheniramine increased risk of moderate Clemastine confusion, dry mouth, Cyproheptadine constipation, and other Dexbrompheniramine anticholinergic Dexchlorpheniramine effects/toxicity. Diphenhydramine (oral) Doxylamine Use of diphenhydramine in Hydroxyzine special situations such Promethazine as acute treatment of Triprolidine severe allergic reaction may be appropriate. Antiparkinson agents Not recommended for Avoid Moderate Strong Rudolph 2008 Benztropine (oral) prevention of Trihexyphenidyl extrapyramidal symptoms with antipsychotics; more effective agents available for treatment of Parkinson disease. Antispasmodics Highly anticholinergic, Avoid Moderate Strong Lechevallier- Belladonna alkaloids uncertain except in Michel 2005 Clidinium-chlordiazepoxide effectiveness. short-term Rudolph 2008 Dicyclomine palliative Hyoscyamine care to Propantheline decrease Scopolamine oral secretions. Antithrombotics Dipyridamole, oral short-acting* May -
Incidence of Post Cross Clamp Ventricular Fibrillation in Isolated Coronary Artery Bypass Surgery Using Del Nido Cardioplegia and Conventional Blood Cardioplegia
Jemds.com Original Research Article Incidence of Post Cross Clamp Ventricular Fibrillation in Isolated Coronary Artery Bypass Surgery Using del Nido Cardioplegia and Conventional Blood Cardioplegia Biju Kambil Thyagarajan1, Anandakuttan Sreenivasan2, Ravikrishnan Jayakumar3, Ratish Radhakrishnan4 1, 2, 3, 4 Department of Cardiovascular and Thoracic Surgery, Government T D Medical College, Alappuzha, Kerala, India. ABSTRACT BACKGROUND The cardiac surgical procedures and surgical outcomes witnessed a dramatic Corresponding Author: improvement with the introduction of cardiopulmonary bypass and cardioplegia Dr. Anandakuttan Sreenivasan, techniques. Ventricular fibrillation immediately after removal of aortic cross clamp is Department of Cardiovascular and an energy consuming process leading to myocardial injury in an already energy Thoracic Surgery, Government T D Medical College, Alappuzha, Kerala, India, depleted heart. Electrical cardioversion, which itself causes myocardial injury, is E-mail: [email protected] required to regain normal rhythm. Prevention of ventricular fibrillation is important in preventing myocardial injury. We retrospectively analysed the incidence of post DOI: 10.14260/jemds/2020/797 cross clamp ventricular fibrillation requiring electrical defibrillation in isolated coronary artery bypass surgery using del Nido cardioplegia and conventional blood How to Cite This Article: cardioplegia. Thyagarajan BK, Sreenivasan A, Jayakumar R, et al. Incidence of post cross clamp METHODS ventricular fibrillation in isolated coronary -
A Proposal for the Clinical Use of Flecainide
A Proposal for the Clinical Use of Flecainide JEFFREY L. ANDERSON, MD, JAMES R. STEWART, MD, and BARRY J. CREVEY, MD Effective antiarrhythmic therapy requires a carefully sponse rate is observed in preventing induction of considered approach, including an understanding sustained ventricular tachycardia, and these pa- of the arrhythmia, the underlying cardiac disease tients should be carefully selected. Flecainide is and the drug’s pharmacokinetics. Flecainide is a promising in the treatment of supraventricular new antiarrhythmic drug that may soon be released tachycardias using atrioventricular nodal or extra- for general use. Flecainide demonstrates unsur- nodal reentrant pathways, although this use is still passed efficacy in chronic ventricular arrhythmias investigational in the United States. The drug’s use in stable patients and may become a first-choice for arrhythmias during acute myocardial infarction drug because of its ease of administration, efficacy requires further study. Flecainide possesses modest and favorable tolerance. Twice-daily dosing with negative inotropic potential. Proarrhythmic or other 100 to 200 mg usually provides effective therapy. adverse reactions have occurred primarily in set- Clinical experience suggests flecainide to be indi- tings of high drug level, poor ventricular function cated in the treatment of uniform and multiform or refractory, malignant arrhythmias, suggesting ventricular premature complexes, coupled ven- caution in these groups. tricular premature complexes, and episodes of nonsustained -
Discharge Advice After Atrial Fibrillation Ablation
Oxford University Hospitals NHS Trust Oxford Heart Centre Discharge advice after Atrial Fibrillation ablation Information for patients page 2 This booklet contains important advice about discharge after your Atrial Fibrillation (AF) ablation. It contains information about what to do when you get home. Contents 1. Discharge summary 4 Follow-up 4 Transport 4 2. What to do when you get home 5 Puncture site care 5 Bleeding 6 Sedation/General Anaesthetic 6 After the catheter ablation 6 Recurrence of AF symptoms - what to do 6 Driving 7 Return to work 8 3. Medication 8 4. How to contact us 9 5. Further information 10 6. Message for doctor reviewing this patient 10 page 3 1. Discharge summary Your Consultant at the John Radcliffe Hospital is: ………………………….…............................................................…….. Follow-up You will be sent an appointment for follow-up in the Arrhythmia clinic. (This appointment will be sent in the post. If you do not receive a date for an appointment within 8 weeks, please call the John Radcliffe Hospital and ask to speak to the secretary of your Consultant. Follow-up appointments are currently planned approximately 3 to 4 months after your procedure.) Transport to your outpatient appointments If you have difficulty getting to your outpatient appointments your GP surgery may have the phone numbers of voluntary transport schemes which operate at subsidised rates. A directory of these services is available at www.oxonrcc.org.uk for residents of the Oxfordshire area. page 4 2. What to do when you get home When you are discharged home, you should have a quiet few days resting to recover from your procedure. -
Guideline for Preoperative Medication Management
Guideline: Preoperative Medication Management Guideline for Preoperative Medication Management Purpose of Guideline: To provide guidance to physicians, advanced practice providers (APPs), pharmacists, and nurses regarding medication management in the preoperative setting. Background: Appropriate perioperative medication management is essential to ensure positive surgical outcomes and prevent medication misadventures.1 Results from a prospective analysis of 1,025 patients admitted to a general surgical unit concluded that patients on at least one medication for a chronic disease are 2.7 times more likely to experience surgical complications compared with those not taking any medications. As the aging population requires more medication use and the availability of various nonprescription medications continues to increase, so does the risk of polypharmacy and the need for perioperative medication guidance.2 There are no well-designed trials to support evidence-based recommendations for perioperative medication management; however, general principles and best practice approaches are available. General considerations for perioperative medication management include a thorough medication history, understanding of the medication pharmacokinetics and potential for withdrawal symptoms, understanding the risks associated with the surgical procedure and the risks of medication discontinuation based on the intended indication. Clinical judgement must be exercised, especially if medication pharmacokinetics are not predictable or there are significant risks associated with inappropriate medication withdrawal (eg, tolerance) or continuation (eg, postsurgical infection).2 Clinical Assessment: Prior to instructing the patient on preoperative medication management, completion of a thorough medication history is recommended – including all information on prescription medications, over-the-counter medications, “as needed” medications, vitamins, supplements, and herbal medications. Allergies should also be verified and documented. -
Resuscitation and Defibrillation
AARC GUIDELINE: RESUSCITATION AND DEFIBRILLATION AARC Clinical Practice Guideline Resuscitation and Defibrillation in the Health Care Setting— 2004 Revision & Update RAD 1.0 PROCEDURE: signs, level of consciousness, and blood gas val- Recognition of signs suggesting the possibility ues—included in those conditions are or the presence of cardiopulmonary arrest, initia- 4.1 Airway obstruction—partial or complete tion of resuscitation, and therapeutic use of de- 4.2 Acute myocardial infarction with cardio- fibrillation in adults. dynamic instability 4.3 Life-threatening dysrhythmias RAD 2.0 DESCRIPTION/DEFINITION: 4.4 Hypovolemic shock Resuscitation in the health care setting for the 4.5 Severe infections purpose of this guideline encompasses all care 4.6 Spinal cord or head injury necessary to deal with sudden and often life- 4.7 Drug overdose threatening events affecting the cardiopul- 4.8 Pulmonary edema monary system, and involves the identification, 4.9 Anaphylaxis assessment, and treatment of patients in danger 4.10 Pulmonary embolus of or in frank arrest, including the high-risk de- 4.11 Smoke inhalation livery patient. This includes (1) alerting the re- 4.12 Defibrillation is indicated when cardiac suscitation team and the managing physician; (2) arrest results in or is due to ventricular fibril- using adjunctive equipment and special tech- lation.1-5 niques for establishing, maintaining, and moni- 4.13 Pulseless ventricular tachycardia toring effective ventilation and circulation; (3) monitoring the electrocardiograph and recogniz- -
MANAGING ATRIAL FIBRILLATION (AF) (MODULE 2) MODULE 2: MANAGING ATRIAL FIBRILLATION Ii CONTENTS
YOUR COMPLETE GUIDE TO ATRIAL FIBRILLATION MANAGING ATRIAL FIBRILLATION (AF) (MODULE 2) MODULE 2: MANAGING ATRIAL FIBRILLATION ii CONTENTS iii Overview of managing AF 28 How are blood thinners used to reduce the risk of stroke in AF? 1 What are the goals of managing AF and atrial flutter? 31 What are the signs of a stroke? 2 Rate Control Strategy: 32 Being realistic when managing AF How is the heart rate controlled? (a) Medicine (b) Procedures 9 Rhythm Control Strategy: How is the heart rhythm controlled? (a) Medicine (b) Procedures 25 Reducing the risk of stroke: How is my stroke risk assessed? HEARTANDSTROKE.CA/AFGUIDE Published: February 2014 © 2014 Canadian Cardiovascular Society and Heart and Stroke Foundation of Canada. All rights reserved. Unauthorized use prohibited. MODULE 2: MANAGING ATRIAL FIBRILLATION iii OVERVIEW OF MANAGING AF AF Diagnosed MODULE 1 Find and Treat Common Causes What is it? Is it harmful? MODULE 2 Manage Arrhythmia Symptoms Assess Stroke Risk (CHADS2) Rate Control Rhythm Control • Medicine • Medicine Blood Thinner, Aspirin, or Nothing • Procedures • Procedures MODULE 3 Living Well with AF What to Expect Understanding Following a from Your AF Common Responses Patient Stories Healthy Lifestyle Management Plan and Finding Support FACT SHEET: OVERVIEW OF MANAGING AF HEARTANDSTROKE.CA/AFGUIDE Published: February 2014 © 2014 Canadian Cardiovascular Society and Heart and Stroke Foundation of Canada. All rights reserved. Unauthorized use prohibited. MODULE 2: MANAGING ATRIAL FIBRILLATION iv WHAT ARE TWO WAYS TO MANAGE AF? While AF is a chronic condition, it can be managed by: • medicine • procedures Medicine is usually tried first to manage symptoms caused by AF. -
Drug Interaction of Amiodarone, Flecainide, Metoprolol and Diltiazem Leading to Heart Block Vijay Kahajuria, Sanjeev Gupta, Roshi, Neelam Rani
JK SCIENCE CASE REPORT Drug Interaction of Amiodarone, Flecainide, Metoprolol and Diltiazem leading to Heart Block Vijay Kahajuria, Sanjeev Gupta, Roshi, Neelam Rani Abstract Amiodarone, flecainide, metoprolol and diltiazem individually are known to cause heart blocks due to their cardiac depressant property but the current case report is worth reporting because it resulted because of drug interaction of multiple drugs due to possible medication error. Key Words Amiodarone, Flecainide, Metoprolol, Diltiazem, Heart Blocks Introduction Adverse Drug Reactions (ADRs) in cardiology are thyroid dysfunction. His hemoglobin levels were 13g/dl, common. There are numerous reports of drug induced total leucocyte count 6000/UL, neutrophils 56.5%, bradycardia and heart block (1). Co-morbid conditions lymphocytes 30.5%, eosinophils 5.2%, monocytes often coexist with cardiac ailments and results in 7.6%,basophils 0.2%, platelet count 1.5 lacs, serum urea- polypharmacy which enhance the chances of drug 33mg/dl, serum creatinine 0.90mg/dl, prothrombin time interactions culminating to adverse events. In the current 10.9 sec ,INR 1.04,hepatitis serology was non reactive, study report patient was prescribed multiple drugs for blood sugar random 182 mg/dl, TSH 1.4uIU/ml, serum cardiac arrhythmia and he presented with heart block sodium 142 mmol/L,serum potassium 5 mmol/L. and bradycardia. Though amiodarone, flecainide, He was prescribed tab.atenolol 20mg and metoprolol and diltiazem individually are known to cause tab.procainamide 20mg which did not bring any relief. heart blocks due to their cardiac depressant property but So radiofrequency ablation was done which was the current case report is worth reporting because it uneventful. -
Flecainide in Ventricular Arrhythmias: from Old Myths to New Perspectives
Journal of Clinical Medicine Review Flecainide in Ventricular Arrhythmias: From Old Myths to New Perspectives Carlo Lavalle 1,*, Sara Trivigno 1 , Giampaolo Vetta 1 , Michele Magnocavallo 1 , Marco Valerio Mariani 1 , Luca Santini 2, Giovanni Battista Forleo 3 , Massimo Grimaldi 4, Roberto Badagliacca 1, Luigi Lanata 5 and Renato Pietro Ricci 6 1 Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy; [email protected] (S.T.); [email protected] (G.V.); [email protected] (M.M.); [email protected] (M.V.M.); [email protected] (R.B.) 2 Department of Cardiology, Ospedale GB Grassi, 00121 Ostia, Italy; [email protected] 3 Department of Cardiology, Azienda Ospedaliera-Universitaria “Luigi Sacco”, 20057 Milan, Italy; [email protected] 4 Department of Cardiology, Ospedale Generale Regionale F. Miulli, Acquaviva delle Fonti, 70021 Bari, Italy; fi[email protected] 5 Medical Affairs Department, Dompé Farmaceutici SpA, 20057 Milan, Italy; [email protected] 6 Centro Cardio-Aritmologico, 00152 Rome, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-335376901 Abstract: Flecainide is an IC antiarrhythmic drug (AAD) that received in 1984 Food and Drug Administration approval for the treatment of sustained ventricular tachycardia (VT) and subsequently Citation: Lavalle, C.; Trivigno, S.; for rhythm control of atrial fibrillation (AF). Currently, flecainide is mainly employed for sinus Vetta, G.; Magnocavallo, M.; Mariani, rhythm maintenance in AF and the treatment of idiopathic ventricular arrhythmias (IVA) in absence M.V.; Santini, L.; Forleo, G.B.; Grimaldi, M.; Badagliacca, R.; Lanata, of ischaemic and structural heart disease on the basis of CAST data. -
Cardiac Ablation: Types and Outcomes
CARDIAC ABLATION: TYPES AND OUTCOMES CARDIOVERSION AND ABLATION JASSIN M. JOURIA Dr. Jassin M. Jouria is a practicing Emergency Medicine physician, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Atrial arrhythmias are serious disorders that can cause an irregular and/or rapid heartbeat, which can lead to serious clinical sequelae. Atrial fibrillation is an example of an atrial arrhythmia that can lead to blood clots, stroke, or heart failure. Electrical cardioversion and ablation are two procedures that can minimize these risks and treat atrial arrhythmia. Each of these treatments have risks and neither offers a complete success rate, but they can be very effective in providing greater quality of life, and extending the life expectancy of patients. -
Stress, Protocols, and Tracers
ASNC IMAGING GUIDELINES ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers a b c Milena J. Henzlova, MD, W. Lane Duvall, MD, Andrew J. Einstein, MD, d e Mark I. Travin, MD, and Hein J. Verberne, MD a Mount Sinai Medical Center, New York, NY b Hartford Hospital, Hartford, CT c New York Presbyterian Hospital, Columbia University Medical Center, New York, NY d Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY e Academic Medical Center, Amsterdam, The Netherlands doi:10.1007/s12350-015-0387-x Abbreviations LEHR Low energy high resolution A2A Adenosine 2a LVEF Left ventricular ejection fraction AHA American Heart Association MBq Megabecquerels ALARA As low as reasonably achievable mCi Millicuries AV Atrioventricular MPI Myocardial perfusion imaging BP Blood pressure MRI Magnetic resonance imaging CBF Coronary blood flow mSv Millisievert CAD Coronary artery disease NE Norepinephrine CPET Cardiopulmonary exercise testing NET1 Norepinephrine transporter-1 DSP Deconvolution of septal penetration NPO Nil per os (nothing by mouth) ECG Electrocardiogram NYHA New York Heart Association EF Ejection fraction PET Positron emission tomography ESRD End-stage renal disease ROI Region of interest HF Heart failure SPECT Single-photon emission computed HFrEF Heart failure (with) reduced ejection tomography fraction TAVR Transcatheter aortic valve replacement HMR Heart-to-mediastinum ratio WR Washout rate ICD Implantable cardioversion defibrillator WPW Wolff-Parkinson White IV Intravenous -
Cardiopulmonary Resuscitation in Prone Position
International Journal of Cardiovascular Sciences. 2021; 34(3):315-318 315 REVIEW ARTICLE Cardiopulmonary Resuscitation in Prone Position Leandro Menezes Alves da Costa,1 Rafael Amorim Belo Nunes,1,2 Thiago Luis Scudeler3 Hospital Alemão Oswaldo Cruz,1 de São Paulo, SP - Brazil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo,2 São Paulo, SP - Brazil Instituto do Coração (InCor),3 São Paulo, SP - Brazil Abstract effectively reduce the difference between transpulmonary dorsal and ventral pressures. In addition, PPV reduces Mechanical ventilation in prone position is an pulmonary compression and improves corporeal alternative strategy for patients with acute respiratory perfusion.6,7 Prone ventilation should be initiated in the discomfort syndrome (ARDS) to improve oxygenation first 36 hours of mechanical ventilation and ideally be in situations when traditional ventilation modalities maintained for 12 to 16 hours.4 have failed. However, due to the significant increase During this period of treatment, the patient may become in ARDS cases during the SARS-CoV-2 pandemic vulnerable to emergency situations, with cardiac arrest and the experimental therapeutic use of potentially as the diagnosis with the worst prognosis. Moreover, arrhythmogenic drugs, cardiopulmonary resuscitation the current use of experimental drugs may increase the in this unusual position could be needed. Therefore, occurrence of malignant arrhythmia. The combination of we will review the available scientific evidence of hydroxychloroquine and azithromycin