Hamad at the cooperative

Hamad, 70 years old
Syncope
1. Cardiovascular
  1. Electrical
    1. Arrythmias
  2. Mechanical
    1. Aortic stenosis
    2. Hypertrophic cardiomyopathy
2. Non-cardiovascular
  1. Orthostatic hypotension
  2. Untreated diabetes
  3. Severe dehydration
  4. Medications/ alcohols
  5. Neurologic
  6. Carotid sinus syndrome
CPR
Glasgow Coma Scale
History taking
1. 1- introduction
  1. 2- W W Q Q A A B A
    1. When
    2. Where
    3. Quality
    4. Quantity
    5. Aggravating
    6. Alleviating
    7. Beliefs
    8. Associated symptoms
      1. Chest pain
      2. Fatigue
      3. Dyspnea
      4. Edema
      5. Hemoptysis
    9. ROS
      1. Medical, Family and Social history
2. 2-
ECG
1. Rhythm
  1. Regular
  2. Irregular
2. Rate
  1. Bradycardia (<60)
    1. Normal (60-100)
      1. Tachycardia (>100)
3. Conduction
  1. Waves
    1. Segments
      1. Intervals
4. Abnormal:
  3. Paroxysmal Supraventricular tachycardia
  4. Sinus tachycardia
  5. Sinus bradycardia
  6. First degree heart block
  7. Second degree heart block
  8. Third degree heart block
  9. Atrial fibrillation
  10. Ventricular fibrillation
Sick sinus syndrome
1. What is affected?
  1. SA node
2. What is the cause?
  1. idiopathic age-related fibrosis and cell atrophy or ischemia
3. What can it manifest as?
  1. Bradycardia or asystolic pause
4. What can it lead to?
  1. Dizziness and syncope
5. How does it happen?
  1. The Na+ channels decrease which could potentially lead to SAN exit block
6. Relation to atrial tachycardia?
  1. Diffuse atrial remodeling can be seen in some patients with SND which may predispose to the development of AF
7. Diagnosed by:
  1. Holter monitor
  2. Exercise testing
  3. Intracardiac electropgysiologic tests
8. Signs and Symptoms:
  1. Fatigue
  2. Weakness
  3. Dizziness
  4. Lightheadness
  5. Fainting
  6. Short breath
9. Risk factors:
  1. Controllable:
    1. High Cholesterol
    2. High BP
    3. Diabetes
    4. Smoking
    5. Alcohol abuse
    6. Stress
    7. Certain medications
  2. Non-controllable
    1. Family history
    2. Congenital heart disorders
    3. Advancing age
    4. Gender
Anti-arrhythmic drugs:
1. Class I
  1. Na+ channel blockers
    1. Ia
      1. Quinidine
        Procainamide
      2. Disopyramide
    2. Ib
      1. Lidocaine
      2. Mexiletime
    3. Ic
      1. Flecainide
      2. Propafenone
2. Class !!
  1. B blockers
    1. Lipophilic
      1. Propranolol
      2. Mteoprolol
    2. Hydrophilic
      1. Atenolol
3. Class !!!
  1. K+ channel blockers
    1. Amiodarone
      1. Dronedarone
        Satolol
        Dofetilide
        Ibutilide
4. Class IV
  1. Ca++ channel blockers
    1. Verapamil
      1. Diltiazem
5. Others
  1. Digoxin
  2. Adenosine
Pacemaker
1. Temporary
  1. Heart attack
  2. Emergency
  3. Overdose
  4. Heart surgery
2. Permanent
  1. Long term problems
3. 1. Indications
    1. Acquired AV block
      1. After myocardial infarction
        Sinus node dysfunction
        Hypertensive carotid sinus
  2. Contraindications
    1. Local infection at implantation site
    2. Active systemic infection with bacteremia
    3. Severe bleeding tendencies
    4. Active anticoagulation therapy
    5. Severe lung disease

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Hamad at the cooperative

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	Created by shahid alzaghari over 7 years ago