22 articles Cardiology

Arrhythmia – outpatient, new Dx

Arrhythmia: (new diagnosis) Order an EKG (in the clinic) Order a Cardionet Holter Monitor (ETSU Heart) Cardiology referral (ETSU Heart) Do NOT start Metoprolol if tachycardic (hold Metoprolol until after Holter monitor is complete!!!) Consider starting Omeprazole if chest pain/acid reflux may also be involved. Labs ordered: CBC, CMP, TSH, Magnesium, Lipid Panel Follow up…

DVT, Acute Arterial Occlusion, PVD

DVT: (therapeutic INR: 2-3) (unilateral LE swolling, may be painful, may be red, may have cords, Hx of immobility – post-orthopedic surgery, long car ride or flights) Confirm Dx: Order Venous Doppler US of bilateral LE Lovenox (therapeutic) 1mg/kg/dose SubQ q12 hours Coumadin 5mg PO qd (starting dose then follow INR and adjust accordingly) Coumadin PO…

Infective Endocarditis

—Risk factors for IE: Age >60 years, male sex, injection drug use, and poor dentition or dental infection. —Comorbid conditions that confer increased risk for IE: Structural heart disease, presence of prosthetic heart valve(s), history of infective endocarditis, presence of an intravascular device, chronic hemodialysis, and HIV infection. Treat: —4-6 weeks of IV antibiotics starting…

Heart Rate: Bradycardia/Tachycardia

Bradycardia: Symptomatic: lightheaded, syncope, chest pain, SOB, palpitations Hold 1 dose of currently prescribed HR meds (Beta-blocker, Calcium channel blocker) Order EKG for all patients with bradycardia: (look for pauses or heart blocks) [Consult Cardiology!] If sinus pauses <2.5s and asymptomatic: No intervention needed. If sinus pauses 2.5-3s and asymptomatic: Consider trial of Atropine. If…

Aspirin – primary prevention

Primary prevention with Aspirin: Male (prevents MI): 45-79 Use this link to calculate risk of MI: http://cvdrisk.nhlbi.nih.gov/calculator.asp Risk factors for CHD include age, diabetes, total cholesterol level, HDL level, blood pressure, and smoking. Female (prevent Stroke): 55-79 Use this link to calculate risk of stroke: Framingham Predictions of Risk of Coronary Heart Disease (CHD) Event and…

Cardiac Arrest

  Of note during cardiac arrest code: Although both Epinephrine and Amiodarone are recommended per ACLS to be given between CPR and defibrillations for Vfib/Vtach, Amiodarone is the only one to improve survival. Epinephrine does NOT improve patient survival to hospital admission. Amiodarone DOES improve survival to hospital admission but has not been proven to…