Cardiac diseases

Dyspnea Dyspnea is shortness of breath or difficulty in breathing. The victim is usually quite aware of the unusual breathing pattern. Shortness of breath can be an indicator of many physical ailments including simple exertion, a panic attack, a blow to the chest, asthma, cardiac disease, as well as exposure to toxic chemicals. If a person is suffering from shortness of breath, evaluate them for additional symptoms and possible exposures. Keep the victim in a sitting position. Remove the victim to fresh air, if possible, and seek medical attention. 

The disadvantage in war periods of relying on a single source of supply for an essential commodity became evident when Java was invaded by the Japanese in March 1942, the world being thereby deprived of about 90 per cent, of its customary supply of cinchona bark. Quinine was ther still considered an indispensable drug for the treatment of malaria an<3 its use had to be restricted to that purpose stocks of quinidine wew similarly reserved for use in cardiac disease, In efforts to deal with th<... 

Primary pulmonary hypertension is a disease of unclear etiology that is characterized by abnormally high mean pulmonary arterial pressures, in the absence of a demonstrable cause. A wide variety of pulmonary and cardiac diseases can lead to secondary pulmonary hypertension. 

Wehrens XH, Lehnart SE, Marks AR (2005) Intracellular calcium release and cardiac disease. Annu Rev Physiol 67 69-98... 

Amantadine is used cautiously in patients with seizure disorders, psychiatric problems, renal impairment, and cardiac disease. Amantadine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. Concurrent use of antihistamines, phenothiazines, tricyclic antidepressants, disopyramide, and quinidine may increase the anticholinergic effects (dry mouth, blurred vision, constipation) of amantadine... 

The tricyclics can cause cardiac-related adverse reactions such as tachycardia and heart block. For this reason, the nurse gives these drugs with caution to the person with preexisting cardiac disease and to the elderly. 

The anabolic steroids are contraindicated in patients with known hypersensitivity to the dni, liver disorders, or serious cardiac disease, and in men with prostate gland disorders (eg, prostate carcinoma and prostate enlargement). The anabolic steroids are classified as Pregnancy Category X dru and should not be administered during pregnancy and lactation. Anabolic steroids are contraindicated when used to enhance physical appearance or athletic performance... 

Older adults are at increased risk for fluid overload because of the increased incidence of cardiac disease and decreased renal function that may accompany old age. Careful monitoring for signs and symptomsof fluid overload (see Table 58-2) isextremely important when administering fluids to older adults... 

Calcium is contraindicated in patients with hypercalcemia or ventricular fibrillation and in patients taking digitalis. Calcium is used cautiously in patients with cardiac disease. Hypercalcemia may occur when calcium is administered with the thiazide diuretics. When calcium is administered with atenolol there is a decrease in Hie effect of atenolol, possibly resulting in decreased beta blockade. There is an increased risk of digitalis toxicity when digitalis preparations are administered with calcium. The clinical effect of verapamil may be decreased when the drug is administered with calcium. Concurrent ingestion of spinach or cereal may decrease file absorption of calcium supplements. 

Influenza vaccine. Influenza vaccine is recommended annually for children age > 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes see MMWR. 2001 50(RR-4) 1-44), and can be administered to all others wishing to obtain immunity. Children aged <12 years should receive vaccine in a dosage appropriate for their age (0.25 mL if age 6-35 months or 0.5 mL if age >3 years). Children aged <8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks. 

LAAM is contraindicated for any patient with ECG abnormalities or any significant cardiac disease. 

In general, for smokers with cardiac disease, the benefits of nicotine replacement therapy outweigh the potential risks. In a safety and efficacy study that included veterans with cardiac disease, smoking concurrently with the nicotine patch was not associated with an increase in adverse events (Joseph et al. 1996). Although bupropion SR is generally well tolerated by smokers, it has not been adequately studied in persons with cardiac disease, and definitive conclusions regarding its safety in this patient population cannot currently be made (Society for Research on Nicotine and Tobacco 2003). 

Joseph AM, Norman SM, Ferry LH, et al The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. N Engl J Med 335 1792-1798, 1996... 

Increased oxygen demand secondary to increased heart rates and blood pressure has been hypothesized to lead to myocardial infarction (especially in patients with fixed coronary disease) and/or ventricular arrhythmias. In patients with no history of cardiac disease, cocaine is thought to induce acute isehemie complications via vasospasm of the coronaries (Ascher et al. 1988). In addition, Virmani et al. (1988) have reported a 20 percent incidence of myocarditis thought to be secondary to accumulated microvascular injuries. 

I B Patients with cardiac disease but without limitations of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnea, or palpitation. 

III C Patients with cardiac disease that results in marked limitation of physical activity. Although patients are comfortable at rest, less than ordinary activity will lead to symptoms. 

IV C, D Patients with cardiac disease that results in an inability to carry on physical activity without discomfort. Symptoms of heart failure are present at rest. With any physical activity, increased discomfort is experienced. Stage D refers to end-stage heart failure patients. 

While PSVT can be associated with myocardial ischemia or infarction, it often occurs in relatively young individuals with no history of cardiac disease. The overall incidence of PSVT is unknown. 

Complicated exacerbation FEV, less than 50% predicted Comorbid cardiac disease Greater than or equal to 3 exacerbations per year Antibiotic therapy in the previous 3 months Above organisms plus drug-resistant pneumococci, P-lactamase-producing H. influenzae and M. catarrhalis, Escherichia coli, Proteus spp., Enterobacter spp., Klebsiella pneumoniae Oral P-Lactam/P-Iactamase inhibitor (amoxicil 1 i n-clavulanate) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin) Intravenous P-Iactam/P-Iactamase inhibitor (ampicillin-sulbactam) Second- or third-generation cephalosporin (cefuroxime, ceftriaxone) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, moxifloxacin)... 

Approximately 80% of patients with a GFR less than 20 to 30 mL/minute develop metabolic acidosis.38 Metabolic acidosis can increase protein catabolism and decrease albumin synthesis, which promote muscle wasting, and alter bone metabolism. Other consequences associated with metabolic acidosis in CKD include worsening cardiac disease, impaired glucose tolerance, altered growth hormone and thyroid function, and inflammation.38... 

Risk factors that may increase the potential for hypotension include elderly age, diabetes, autonomic neuropathy, uremia, and cardiac disease.46 The symptoms associated with hypotension during dialysis include dizziness, nausea, vomiting, sweating, and chest pain. 

In patients younger than age 65 with overt hypothyroidism, the average LT4 replacement dose is 1.6 mcg/kg per day (use ideal body weight in obese patients25). If there is no history of cardiac disease, these patients may be started on the full replacement dose. The full replacement dose in patients over age 75 is lower, about 1 mcg/kg per day.26 In the elderly, the starting dose is 25 to 50 meg/day, and the dose is titrated to the... 

This is a life-threatening condition owing to severe, longstanding hypothyroidism and has a mortality rate of 60% to 70%. These patients are given 300 to 500 meg intravenous LT4 initially, using caution in patients with underlying cardiac disease. While administration of T3 would provide a more... 

Elderly patients or those with cardiac disease should be started at a lower LT4 dose (e.g., 12.5-25 mcg/day). 

A thorough medical history with emphasis on cardiac disease must be taken before starting any treatment for ED to assess for ability to safely perform sexual activity and to assess for possible drug interactions. 

I NF can affect any age group. Although the risk of NF is higher in patients with underlying diseases (specifically diabetes, alcoholism, cardiac disease, and peripheral vascular disease), healthy hosts can become infected as well.20... 

Certain conditions have been associated more commonly with IE due to preexisting cardiac disease in the presence of a transient bacteremia. In an effort to prevent the development of IE, prophylactic treatment generally is recommended for these at-risk patients. Although there are no well-controlled clinical studies of these recommendations, it is thought that if antibiotics are given just prior to a procedure, the number of bacteria may be decreased in the bloodstream and prevent the bacteria from adhering to the valves. 

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