Heart failure tachycardia

The Class I agents have many similar side effects and toxicities. The anticholinergic side effects include dry mouth, constipation, and urinary hesitancy and retention. Common gastrointestinal (GI) side effects include nausea, vomiting, diarrhea, and anorexia. Cardiovascular adverse effects are hypotension, tachycardia, arrhythmias, and myocardial depression, especially in patients with congestive heart failure. Common central nervous system (CNS) side effects are headache, dizziness, mental confusion, hallucinations, CNS stimulation, paraesthesias, and convulsions. 

The amide local anaesthetic lidocaine may also be used as an antianhythmic for ventricular tachycardia and exra-systoles after injection into the blood circulation. Drugs with high lipid solubility such as bupivacaine cannot be used for these purposes because their prolonged binding to the channel may induce dysrhythmias or asystolic heart failure [3]. Systemically applied lidocaine has also been used successfully in some cases of neuropathic pain syndromes [4]. Here, electrical activity in the peripheral nervous system is reduced by used-dependent but incomplete sodium channel blockade. 

Sodium and fluid retention, hyperglycemia, glycosuria, tachycardia, congestive heart failure... 

Nicardipine 1-A hour 5-10 minute 2.5-15 mg/hour Tachycardia, headache, heart failure, flushing, peripheral edema Long half-life, precluding rapid titration... 

Direct Vasodilators Isosorbide dinitrate 20 mg and hydralazine 37.5 (BiDil) 1-2 tablets three times a day Minoxidil (Loniten) Hydralazine Heart failure (isosorbide dinitrate + hydralazine in African-Americans) A-HeFT66 Edema (minoxidil) Tachycardia Lupus-like syndrome (hydralazine) ... 

Nicardipine hydrochloride 5-15 mg/hour IV 5-10 minutes 15-30 minutes, may exceed 4 hours Tachycardia, headache, flushing, local phlebitis Most hypertensive emergencies except acute heart failure use with caution with coronary ischemia... 

FIGURE 6-10. Decision algorithm for termination of paroxysmal supraventricular tachycardia. HF, heart failure LVEF, left ventricular ejection fraction PSVT, paroxysmal supraventricular tachycardia. (Algorithm adapted with permission from Tisdale JE, Moser LR. Tachyarrhythmias. In Mueller BA, Bertch KE,... 

AF, atrial fibrillation HF, heart failure 10, intraosseous PSVT, paroxysmal supraventricular tachycardia VF, ventricular fibrillation VT, ventricular tachycardia. 

Blockers are contraindicated in patients with decompensated heart failure unless it is caused solely by tachycardia (high output). Other contraindications include sinus bradycardia, concomitant therapy with monoamine oxidase inhibitors or tricyclic antidepressants, and patients with spontaneous hypoglycemia. Side effects include nausea, vomiting, anxiety, insomnia, lightheadedness, bradycardia, and hematologic disturbances. 

Adverse events include ulceration of nasal mucosa and nasal septal collapse, tachycardia, heart failure, hyperthermia, shock, seizures, psychosis (similar to paranoid schizophrenia), and sudden death. 

Other adverse events may include pancytopenia, aplastic anemia, neutropenia, leukopenia, thrombocytopenia, lymphopenia, leukocytosis, lymphadenopathy, coagulation disturbances, hypotension/shock, heart failure, angina/MI, tachycardia, bradycardia, tachypnea/hyperventilation, abnormal chest sounds, pneumonia/pneumonitis, rash, urticaria, pruritus, erythema, flushing, diaphoresis, diarrhea, bowel infarction, arthralgia, arthritis, blindness, blurred vision, diplopia, hearing loss, otitis media, tinnitus, vertigo, photophobia, conjunctivitis, nasal/ear stuffiness, and anuria/oliguria. 

Methanol Inebriation similar to EtOH, metabolic acidosis, tachycardia, HTN, AMS, unresponsive pupils, acute heart failure, cardiac arrhythmias... 

A patient with heart failure developed a serious abnormal heart rhythm, ventricular tachycardia, and it was decided to treat this with lig-nocaine (also known as lidocaine) by the intravenous route. He was given a loading dose designed to raise the plasma concentration to an effective 2 mg/1, and then given a constant-rate intravenous infusion aimed at maintaining that concentration. In about an hour he was observed to be tremulous and then had a brief generalized convulsion (a fit). The plasma lig-nocaine concentration was found to be 8 mg/1 (desired therapeutic range 1 - no more than 5 mg/1). 

Severe congestive heart failure (CHF) is associated with sympathetic activation and down-regulation of -adrenoceptors. The beneficial effect of cautiously used j8-blockers in CHF is believed to be based upon the suppression of tachycardia and tachy-arrhythmia. Upregulation of j8-adrenoceptors can also be thought of as a beneficial factor, although the evidence for this is meagre. 

Hydralazine and dihydralazine are predominantly arterial vasodilators which cause a reduction in peripheral vascular resistance but also reflex tachycardia and fluid retention. They were used in the treatment of hypertension, in combination with a -blocker and a diuretic. Long-term use of these compounds may cause a condition resembling lupus erythematodes with arthrosis, dermatitis and LE-cells in the blood. This risk is enhanced in women and in patients with a slow acetylator pattern. When combined with the venous vasodilator isosorbide (an organic nitrate) hydralazine was shown to be mildly beneficial in patients with congestive heart failure (V-HEFT I Study). Hydralazine and dihydralazine have been replaced by other therapeutics, both in hypertension treatment and in the management of heart failure. 

Most side effects associated with hydralazine administration are due to vasodilation and the reflex hemodynamic changes that occur in response to vasodilation. These side effects include headache, flushing, nasal congestion, tachycardia, and palpitations. More serious manifestations include myocardial ischemia and heart failure. These untoward effects of hydralazine are greatly attenuated when the drug is administered in conjunction with a (3-blocker. 

Substantial tachycardia may lead to ischemic cardiac events orworsened heart failure. 

Excessive catecholamine action is an important aspect of the pathophysiology of hyperthyroidism, especially in relation to the heart (see Chapter 38). The 13 antagonists are beneficial in this condition. The effects presumably relate to blockade of adrenoceptors and perhaps in part to the inhibition of peripheral conversion of thyroxine to triiodothyronine. The latter action may vary from one 13 antagonist to another. Propranolol has been used extensively in patients with thyroid storm (severe hyperthyroidism) it is used cautiously in patients with this condition to control supraventricular tachycardias that often precipitate heart failure. 

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