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Adult congenital Heart Disease in clinical practice
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💊Metoprolol💊
Indications
Supraventricular arrhythmia, angina pectoris, hypertension, myocardial infarction; migraine prophylaxis; hyperthyroidism, heart failure.
Availability
TABLET 10, 25, 50 and 100 mg INJECTION100 mg/2 ml, 250 mg/2 ml, 500 mg/2 ml. CAPSULE 12.5, 25, 50 and 100 mg
Dose
Oral
Heart failure: Initiating dose 12.5 - 25 mg once a day, Maximum dose: 200 mg once a day; Hypertension: initially 100 mg daily, increase if required to 200 mg in two divided doses (max 400 mg daily). Angina: 50 mg daily, up to 300 mg daily in 2 to 3 divided doses if necessary.
Intravenous injection
Arrhythmia: up to 5 mg at a rate of 1 to 2 mg per min, repeated after 5 min if necessary (max dose 10 to 15 mg). Arrythmia developing during anaesthesia: 2 to 4 mg during induction.
Contraindications
Asthma (important: see Bronchospasm below), uncontrolled heart failure, Prinzmetal's angina, marked bradycardia, hypotension, sick sinus syndrome, second- or third- degree AV block, cardiogenic shock, metabolic acidosis, severe peripheral arterial disease; pheochromocytoma (apart from specific use with alpha-blockers).
Beta-blockers, including those considered to be cardioselective, should not be given to patients with a history of asthma or bronchospasm. However, in rare situations where there is no alternative a cardioselective beta-blocker is given to these patients with extreme caution and under specialist supervision.
Precautions
Avoid abrupt withdrawal especially in ischaemic heart disease, first-degree AV block, portal hypertension (risk of deterioration in liver function); diabetes; history of obstructive airways disease (introduce cautiously and monitor lung function); myasthenia gravis; symptoms of hypoglycaemia and thyrotoxicosis may be masked; history of hypersensitivity-may increase sensitivity to allergens and result in more serious hypersensitivity response; also may reduce response to adrenaline (epinephrine); reduce dose of oral propranolol in hepatic impairment; renal impairment; lactation; pregnancy
Adverse Effects
Gastro-intestinal disturbances; bradycardia, heart failure, hypotension, conduction disorders; peripheral vasoconstriction (including exacerbation of intermittent claudication and Raynaud’s phenomenon); bronchospasm; dyspnoea; headache; fatigue; sleep disturbances; paraesthesia; dizziness; vertigo; psychosis; sexual dysfunction; purpura; thrombocytopenia; visual disturbances; exacerbation of psoriasis; alopecia; rarely, rashes and dry eyes (reversible on withdrawal); on infusion venous irritation and thrombophlebitis; agranulocytosis; hyperglycemia; myocardial depression.
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Indications
Supraventricular arrhythmia, angina pectoris, hypertension, myocardial infarction; migraine prophylaxis; hyperthyroidism, heart failure.
Availability
TABLET 10, 25, 50 and 100 mg INJECTION100 mg/2 ml, 250 mg/2 ml, 500 mg/2 ml. CAPSULE 12.5, 25, 50 and 100 mg
Dose
Oral
Heart failure: Initiating dose 12.5 - 25 mg once a day, Maximum dose: 200 mg once a day; Hypertension: initially 100 mg daily, increase if required to 200 mg in two divided doses (max 400 mg daily). Angina: 50 mg daily, up to 300 mg daily in 2 to 3 divided doses if necessary.
Intravenous injection
Arrhythmia: up to 5 mg at a rate of 1 to 2 mg per min, repeated after 5 min if necessary (max dose 10 to 15 mg). Arrythmia developing during anaesthesia: 2 to 4 mg during induction.
Contraindications
Asthma (important: see Bronchospasm below), uncontrolled heart failure, Prinzmetal's angina, marked bradycardia, hypotension, sick sinus syndrome, second- or third- degree AV block, cardiogenic shock, metabolic acidosis, severe peripheral arterial disease; pheochromocytoma (apart from specific use with alpha-blockers).
Beta-blockers, including those considered to be cardioselective, should not be given to patients with a history of asthma or bronchospasm. However, in rare situations where there is no alternative a cardioselective beta-blocker is given to these patients with extreme caution and under specialist supervision.
Precautions
Avoid abrupt withdrawal especially in ischaemic heart disease, first-degree AV block, portal hypertension (risk of deterioration in liver function); diabetes; history of obstructive airways disease (introduce cautiously and monitor lung function); myasthenia gravis; symptoms of hypoglycaemia and thyrotoxicosis may be masked; history of hypersensitivity-may increase sensitivity to allergens and result in more serious hypersensitivity response; also may reduce response to adrenaline (epinephrine); reduce dose of oral propranolol in hepatic impairment; renal impairment; lactation; pregnancy
Adverse Effects
Gastro-intestinal disturbances; bradycardia, heart failure, hypotension, conduction disorders; peripheral vasoconstriction (including exacerbation of intermittent claudication and Raynaud’s phenomenon); bronchospasm; dyspnoea; headache; fatigue; sleep disturbances; paraesthesia; dizziness; vertigo; psychosis; sexual dysfunction; purpura; thrombocytopenia; visual disturbances; exacerbation of psoriasis; alopecia; rarely, rashes and dry eyes (reversible on withdrawal); on infusion venous irritation and thrombophlebitis; agranulocytosis; hyperglycemia; myocardial depression.
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💊Amlodipine💊
Indications
Angina, hypertension, coronary artery disease.
Availability
TABLETS 1.25, 2.5, 5, 7.5, 10 and 20 mg.
Dose
Oral
Angina: Adult- Initially 5 mg once daily, increased if necessary; max. 10 mg once daily.
Hypertension: Adult- Initially 5 mg once daily, increased if necessary; max. 10 mg once daily.
Elderly- Initial dose- 2.5 mg once daily.
Contraindications
Significant aortic stenosis, sinoatrial node disease, hypersensitivity to dihydropyridines, cardiogenic shock, unstable angina; interactions.
Precautions
Hypotension, myocardial infarction,
impaired renal function sick-sinus syndrome, severe ventricular dysfunction, hypertrophic
cardiomyopathy, severe aortic stenosis, elderly, children, pregnancy lactation; hepatic impairment.
Adverse Effects
Arrhythmias, postural hypotension; dizziness, ankle edema, hypoesthesia, flatulence, dizziness, blurred vision, facial flushing, dyspnoea, asthenia, muscle cramps, conduction system delay, abdominal pain, headache; sleep disturbances, fatigue.
@cardiology
Indications
Angina, hypertension, coronary artery disease.
Availability
TABLETS 1.25, 2.5, 5, 7.5, 10 and 20 mg.
Dose
Oral
Angina: Adult- Initially 5 mg once daily, increased if necessary; max. 10 mg once daily.
Hypertension: Adult- Initially 5 mg once daily, increased if necessary; max. 10 mg once daily.
Elderly- Initial dose- 2.5 mg once daily.
Contraindications
Significant aortic stenosis, sinoatrial node disease, hypersensitivity to dihydropyridines, cardiogenic shock, unstable angina; interactions.
Precautions
Hypotension, myocardial infarction,
impaired renal function sick-sinus syndrome, severe ventricular dysfunction, hypertrophic
cardiomyopathy, severe aortic stenosis, elderly, children, pregnancy lactation; hepatic impairment.
Adverse Effects
Arrhythmias, postural hypotension; dizziness, ankle edema, hypoesthesia, flatulence, dizziness, blurred vision, facial flushing, dyspnoea, asthenia, muscle cramps, conduction system delay, abdominal pain, headache; sleep disturbances, fatigue.
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Atrial Septal Defect (ASD), Animation.
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How Respiratory Pump Affects Venous Return, Animation.
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QRS Transitional Zone (ECG), R Wave Progression Explained, Animation
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ECG Interpretation Basics continued - ST Segment Changes, Animation.
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ECG Interpretation Basics, Animation.
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💊Verapamil💊
Indications
Angina, including stable, unstable and Prinzmetal angina; arrhythmias; ischaemic heart disease; migraine.
Availability
TABLETS 40, 80, 120 and 240 mg (SR); INJECTION 2 ml (5 mg/2 ml).
Dose
Oral
Adult- 80 to 120 mg 3 times daily (120 mg 3 times daily usually required in Prinzmetal angina). Supraventricular arrhythmias: 40 to 120 mg 3 times daily.
Intravenous injection
Adult- Supraventricular arrhythmias: 5 to 10 mg over 2 min (preferably with ECG monitoring).
Elderly- Paroxysmal tachyarrhythmias: 5 to 10 mg over 3 min, further 5 mg may be given after 5 to 10 min if required.
Contraindications
Hypotension, bradycardia, second- and third-degree atrioventricular block, sinoatrial block, sick sinus syndrome; cardiogenic shock; history of heart failure or significantly impaired left ventricular function (even if controlled by therapy); atrial flutter or fibrillation complicating Wolff-ParkinsonWhite syndrome; porphyria; platelet dysfunction.
Precautions
First-degree atrioventricular block; kidney impairment; cirrhosis patients; acute phase of myocardial infarction (avoid if bradycardia, hypotension, left ventricular failure); hepatic impairment children (specialist advice only); lactation; pregnancy interactions.
Adverse Effects
Constipation; less commonly nausea, vomiting, flushing, headache, dizziness, fatigue, ankle oedema; rarely, allergic reactions (erythema, pruritus, urticaria, angioedema, Stevens-Johnson syndrome); myalgia; arthralgia, paraesthesia, increased prolactin concentration; gynaecomastia and gingival hyperplasia on long-term treatment; with high doses, hypotension, heart failure, bradycardia, heart block and asystole (due to negative inotropic effect), impotence; hepatotoxicity; hyperprolactinemia; myoclonic dystonia.
@cardiology
Indications
Angina, including stable, unstable and Prinzmetal angina; arrhythmias; ischaemic heart disease; migraine.
Availability
TABLETS 40, 80, 120 and 240 mg (SR); INJECTION 2 ml (5 mg/2 ml).
Dose
Oral
Adult- 80 to 120 mg 3 times daily (120 mg 3 times daily usually required in Prinzmetal angina). Supraventricular arrhythmias: 40 to 120 mg 3 times daily.
Intravenous injection
Adult- Supraventricular arrhythmias: 5 to 10 mg over 2 min (preferably with ECG monitoring).
Elderly- Paroxysmal tachyarrhythmias: 5 to 10 mg over 3 min, further 5 mg may be given after 5 to 10 min if required.
Contraindications
Hypotension, bradycardia, second- and third-degree atrioventricular block, sinoatrial block, sick sinus syndrome; cardiogenic shock; history of heart failure or significantly impaired left ventricular function (even if controlled by therapy); atrial flutter or fibrillation complicating Wolff-ParkinsonWhite syndrome; porphyria; platelet dysfunction.
Precautions
First-degree atrioventricular block; kidney impairment; cirrhosis patients; acute phase of myocardial infarction (avoid if bradycardia, hypotension, left ventricular failure); hepatic impairment children (specialist advice only); lactation; pregnancy interactions.
Adverse Effects
Constipation; less commonly nausea, vomiting, flushing, headache, dizziness, fatigue, ankle oedema; rarely, allergic reactions (erythema, pruritus, urticaria, angioedema, Stevens-Johnson syndrome); myalgia; arthralgia, paraesthesia, increased prolactin concentration; gynaecomastia and gingival hyperplasia on long-term treatment; with high doses, hypotension, heart failure, bradycardia, heart block and asystole (due to negative inotropic effect), impotence; hepatotoxicity; hyperprolactinemia; myoclonic dystonia.
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Bundle Branch Block, Animation.
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Baroreflex Regulation of Blood Pressure, Animation.
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Cardiac Axis Interpretation, Animation.
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💊Diltiazem💊
Indications
Angina pectoris due to coronary artery spasm; chronic stable angina; cardiac arrhythmia.
Availability
TABLETS/TABLETS (SR) 30, 60, 90, 120, 180 and 240 mg; CAPSULE 60, 90, 120, 180 and 240 mg; INJECTION 5 ml (25 mg/5 ml).
Dose
Oral
Adult-30 mg 2 to 5 times a day before food and at night (bed time), increase gradually to 240 mg in 3 to 4 divided doses daily.
Child- Not recommended.
Cardiac arrhythmia
Adult-I Initially 250 µg/kg by i.v. bolus over 2 min.
Contraindications
Severe bradycardia; left ventricular failure with pulmonary congestion; second- or third-degree AV block (unless pacemaker fitted); sick sinus syndrome; lactation.
Precautions
Reduce dose in hepatic and renal impairment; heart failure or significantly impaired left ventricular function; bradycardia (avoid if severe); first degree AV block; or prolonged PR interval; interactions sinoatrial nodal dysfunction; pregnancy.
Adverse Effects
Bradycardia, sino-atrial block, AV block; palpitation; dizziness; hypotension, malaise; asthenia; headache; hot flushes; gastrointestinal disturbances; oedema rarely, rashes (including erythema multiforme and exfoliative dermatitis), photosensitivity; hepatitis; gynaecomastia; gum hyperplasia; extrapyramidal symptoms; depression reported; gastrointestinal haemorrhage; sinus arrest
@cardiology
Indications
Angina pectoris due to coronary artery spasm; chronic stable angina; cardiac arrhythmia.
Availability
TABLETS/TABLETS (SR) 30, 60, 90, 120, 180 and 240 mg; CAPSULE 60, 90, 120, 180 and 240 mg; INJECTION 5 ml (25 mg/5 ml).
Dose
Oral
Adult-30 mg 2 to 5 times a day before food and at night (bed time), increase gradually to 240 mg in 3 to 4 divided doses daily.
Child- Not recommended.
Cardiac arrhythmia
Adult-I Initially 250 µg/kg by i.v. bolus over 2 min.
Contraindications
Severe bradycardia; left ventricular failure with pulmonary congestion; second- or third-degree AV block (unless pacemaker fitted); sick sinus syndrome; lactation.
Precautions
Reduce dose in hepatic and renal impairment; heart failure or significantly impaired left ventricular function; bradycardia (avoid if severe); first degree AV block; or prolonged PR interval; interactions sinoatrial nodal dysfunction; pregnancy.
Adverse Effects
Bradycardia, sino-atrial block, AV block; palpitation; dizziness; hypotension, malaise; asthenia; headache; hot flushes; gastrointestinal disturbances; oedema rarely, rashes (including erythema multiforme and exfoliative dermatitis), photosensitivity; hepatitis; gynaecomastia; gum hyperplasia; extrapyramidal symptoms; depression reported; gastrointestinal haemorrhage; sinus arrest
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Heart Teams for Treatment of Cardiovascular disease
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@MBmedicalbook 2019.pdf
16.3 MB
Cardiac Electrophysiology Without Fluoroscopy
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💊Lidocaine💊
Indications
Ventricular arrhythmias (especially after myocardial infarction); local anaesthesia.
Availability
JELLy 2% w/v INJECTION vial 30 ml (1, 2%w/v), 50 ml (21.3 mg/ml); 2%/50 ml; ampoule 5%/2 ml OINTMENT 5% w/v
Dose
Adult- Ventricular arrhythmias: loading dose of 50 to 100 mg (or 1 to 1.5 mg/kg) at a rate of 25 to 50 mg/min by intravenous injection, followed immediately by intravenous infusion of 1 to 4 mg/min, with ECG monitoring of all patients (reduce infusion dose if required for longer than 24 h).
Contraindications
Sino-atrial disorder; any grade of atrioventricular block or any other type of conduction disturbances, severe myocardial depression, acute porphyria or hypovolaemia, bradycardia, cardiac decompensation.
Precautions
Lower dosage in congestive heart failure, bradycardia, ECG monitoring must during therapy, pediatrics; hypotension; renal impairment; porphyria; debilitated patients; hepatic impairment marked hypoxia; severe respiratory depression; following cardiac surgery and in elderly; lactation; interactions pregnancy
Adverse Effects
Dizziness; paraesthesia; drowsiness, confusion; apnoea, respiratory depression; coma; seizures and convulsions; hypotension, arrhythmias, heart block; cardiovascular collapse and bradycardia (may lead to cardiac arrest); nystagmus often an early sign of lidocaine overdosage; blurred vision, disorientation.
@cardiology
Indications
Ventricular arrhythmias (especially after myocardial infarction); local anaesthesia.
Availability
JELLy 2% w/v INJECTION vial 30 ml (1, 2%w/v), 50 ml (21.3 mg/ml); 2%/50 ml; ampoule 5%/2 ml OINTMENT 5% w/v
Dose
Adult- Ventricular arrhythmias: loading dose of 50 to 100 mg (or 1 to 1.5 mg/kg) at a rate of 25 to 50 mg/min by intravenous injection, followed immediately by intravenous infusion of 1 to 4 mg/min, with ECG monitoring of all patients (reduce infusion dose if required for longer than 24 h).
Contraindications
Sino-atrial disorder; any grade of atrioventricular block or any other type of conduction disturbances, severe myocardial depression, acute porphyria or hypovolaemia, bradycardia, cardiac decompensation.
Precautions
Lower dosage in congestive heart failure, bradycardia, ECG monitoring must during therapy, pediatrics; hypotension; renal impairment; porphyria; debilitated patients; hepatic impairment marked hypoxia; severe respiratory depression; following cardiac surgery and in elderly; lactation; interactions pregnancy
Adverse Effects
Dizziness; paraesthesia; drowsiness, confusion; apnoea, respiratory depression; coma; seizures and convulsions; hypotension, arrhythmias, heart block; cardiovascular collapse and bradycardia (may lead to cardiac arrest); nystagmus often an early sign of lidocaine overdosage; blurred vision, disorientation.
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