Ablation for Aflutter is usually very successful to eliminate the irregular rhythm. As you get more frequent ablations for Aflutter they become less successful. #OTILTW @MayaHolsen
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Patients started on sotalol need to have their QTc monitored for 5 doses. This is because sotalol can cause QT prolongation and the max effect is seen at steady state. ECG should be monitored 2 hours after the dose. #OTILTW @MayaHolsen
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In patients who have recieved a pacemaker who are getting paced on it their QT interval may look long. This is usually because the QRS complex is wide as the signal to squeeze passes through the ventricles in a non-native matter. #OTILTW @MayaHolsen
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Entresto is made up of sacubitril and valsartan. Sacubitril inhibits neprilysin. Neprilysin breaks down BNP. In patients starting Entresto, their BNP will increase as their body starts breaking it down. However long term entresto will decrease BNP. #OTILTW @MayaHolsen
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In older patients on donepezil it can cause heart block. This is because donepezil can cause bradycardia and in patients with a sicker conduction system this bradycardia can progress to heart block. #OTILTW @MayaHolsen
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For coronary vasospasm CCB are the drug of choice. But when it is cocaine induced vasospasm nonselective beta blockers should be used. Agents that have both beta and alpha blockade like labetalol or carvedilol are preferred in that population. #OTILT @MayaHolsen
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Hypervolemic hyponatremia can occur due to SIADH. The usual treatment includes fluid restriction, IV furosemide, and 3% NS. If the serum sodium is less than 125 use of vasopressin antagonists can be considered such as Tolvaptan and Conivaptan. @MayaHolsen #OTILTW
To treat ventricular tachycardia (VT) acutely treatment options can include lidocaine and amiodarone. Lidocaine is lipophilic and can cross the blood brain barrier. Amiodarone causes iodine deposits that can be of concern when used chronically. @MayaHolsen #OTILTW
When a patient has ventricular tachycardia and HFrEF it is acceptable to use two beta blockers (BB). When initiating sotalol with a HFrEF BB already on board, the HFrEF BB dose should be cut in half. @MayaHolsen #OTILTW
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For patients with heart block (HB) medications that may be causing it should be removed (BB, CCB, digoxin, etc.) If the HB is irreversible a pacemaker (PM) may need to be placed in the patient and heparin should be held 24 hrs before + 48 hrs after PM placement @MayaHolsen #OTILT
A serum potassium goal in a cardiac unit is 4 mEq/L. When repleting potassium each 10 mEq we give a patient will increase their serum potassium by 0.1 mEq. It is better to use oral potassium when possible because IV potassium is caustic and can be painful #OTILT
Diuretics will only deplete your intravascular volume. When patients are fluid overloaded the extra fluid is in their extravascular space. Thus we can only diuresis patients so quickly because the fluid needs to move intravascularly #OTILT