Nagelhout - Antiarrhythmics - Exam 2 Flashcards
(51 cards)
In general, drugs that _ the heart are anti-arrhythmic
depress
T/F People experience arrhythmias more under GA than awake
false.
less under anesthesia than awake
A drug that _ the heart is typically arrhythmogenic
stimulates
Most successful way to treat arrhythmias:
ablations
Class I Antiarrhythmics
Na Channel blockers!! -slow phase 0 depolarization, acts mainly on ventricles
IA-after-prolong AP
-procainamide, quinidine, disopyramide
IB-before-shorten AP repolarization
-lidocaine, mexilitine, phenytoin
IC-depression
-flecainide, propafenide
Class II Antiarrhythmics
Beta Blockers! - inhibit phase 4 depolarization
-esmolol, propranolol, metoprolol, timolol, atenolol, nadolo, carvedilol
Class III Antiarrhythmics
K Channel blockers! - prolongs repolarization
-AMIO, sotalol, ibutilide, dofetilide
Class IV Antiarrhythmics
Ca Channel Blockers! - acts mainly on Atria/ SA/AV node
-Verapamil, Diltiazem
Class Other/V Antiarrhythmics
-Adenosine, Digoxin, Atropine
In the heart, Ca++ channels leak in which areas mainly:
atria, SA + AV node
In the heart, Na+ channels leak in which areas mainly:
ventricles
Which class of antiarrhythmics have a LA effect on heart?
Class I -Na channel blockers
Which antiarrhtyhmic class is preferrable for Afib normally
Class IV, CCB
Most common cause of arrhythmias during anesthesia:
pt not deep enough
Arrhythmias
-general factors
-age
-LA enlargement
-high adrenergic state
-hypoxia
-hypovolemia
-reperfusion arrhythmia
-HTN
-pulm disease
-beta blocker withdraw
Arrhythmias
-structural factros
-CAD
-MI
-valve/congenital heart disease
-cardiomyopathy
-SSS or long QT syndrome
-WPW
-secondary heart disease
-brady
-AV HB
Arrhythmia
-transient imbalances/factors
-lytes
-stress
-laryngoscopy, hypoxia, hypoxemia
-device malfunctions
-diagnostic interventions (interrogations)
-surgical stim
-central venous caths
4 main cardiac risk factors:
-Unstable coronary syndrome
-Decomp. HF
-Significant Arrhythmias
-Severe valve disease
Major cardiac risks
-Unstable Coronary Syndrome
-acute or recent (<6mo) MI
-severe/unstable angina
Major cardiac risks:
-Decomp HF
-NYHA Class IV, new-onset or worsening
Major cardiac risks:
-Significant Arrhythmias
-high grade AV blk
-2’2 blk
-3’ AV Blk
-symptomatic vent. arrhythmias
-supraventricular arrhythmias (afib w uncontrolled rate>100)
-symptomatic brady
-newly recognized VT
Major cardiac risks:
-Severe Valve Disease
-Severe AS w/ mean pressure grad >40mmHg, aortic valve area<1cm^2, or symptomatic
-symptomatic Mitral stenosis, exertional presyncope, dyspnea on exertion, HF
Scariest cardiac risk factor to be on edge about:
HF
-#1 risk for mortality/morbidity for anesthesia
Intermediate cardiac risk factors
-mild angina
-previous MI or pathologic Q waves, but doing ok
-compensated/previous HF
-IDDM
-renal insufficiency
