Tachycardia treatment

Much more is known about overdose with the immediate-release formulation of bupropion than with the newer, SR and XL formulations. Reported reactions to overdose with the immediate-release form include seizures, hallucinations, loss of consciousness, and sinus tachycardia. Treatment of overdose should include induction of vomiting, administration of activated charcoal, and electrocardiographic and electroencephalographic monitoring. For seizures, an intravenous benzodiazepine preparation is recommended. 

Valproate overdose results in increasing sedation, confusion, and ultimately, coma. The patient may also manifest hyperreflexia or hyporeflexia, seizures, respiratory suppression, and supraventricular tachycardia. Treatment should include gastric lavage, electrocardiographic monitoring, treatment of emergent seizures, and respiratory support. 

Another use for defibrillators is to shock either atrial flutter or fibrillation, which are abnormally rapid atrial rhythms. These atrial rhythms are much less likely to spontaneously proceed rapidly to death than ventricular arrhythmias. Using electrical shock to treat rapid heart arrhythmias other than VF is usually referred to as cardioversion and hence some users refer to the tachycardia treatment devices as cardioverter—defibrillators. Cardiovertor and defibrillator treatment is different from pacemaker treatment (discussed elsewhere in this book) because a pacemaker stimulates a slowly beating heart and uses much weaker shocks. Pacemaking increases the rate of the relatively healthy heart, which increases blood flow. 

As with pacemaker analysis an electrocardiogram (EGG) cable can be attached to the patient to provide EGG rhythm strips. They can aid in assessing the pacing and sensing functions of the IGD. "Marker chaimel" annotations are also available. They vary from those for pacemakers in that additional annotations are used to delineate ventricular events that occur within the various IGD tachycardia treatment zones (i.e. "VT" for VT zone or "VE" for VF zone for the below example). These tachycardia annotations differ between IGD manufacturers, but tend to convey similar information. 

Cardiovascuiar system -sinoatriai node Decrease in heart rate and the strength of heart contractions Treatment of tachycardia Treatment of excessive vagal discharge... 

Treatment of Manic—Depressive Illness. Siace the 1960s, lithium carbonate [10377-37-4] and other lithium salts have represented the standard treatment of mild-to-moderate manic-depressive disorders (175). It is effective ia about 60—80% of all acute manic episodes within one to three weeks of adrninistration. Lithium ions can reduce the frequency of manic or depressive episodes ia bipolar patients providing a mood-stabilising effect. Patients ate maintained on low, stabilising doses of lithium salts indefinitely as a prophylaxis. However, the therapeutic iadex is low, thus requiring monitoring of semm concentration. Adverse effects iaclude tremor, diarrhea, problems with eyes (adaptation to darkness), hypothyroidism, and cardiac problems (bradycardia—tachycardia syndrome). 

Enca.inide, Encainide hydrochloride, a ben2amide derivative, is effective in the treatment of ventricular arrhythmias and refractory ventricular tachycardia (1,2). 

Dlgltoxin. Digitoxin is a cardiac glycoside obtained from Digitalis purpurea. Digitoxin is indicated in the treatment of atrial flutter, atrial fibrillation, and supraventricular tachycardia. Its electrophysiologic and adverse effects are similar to those described for digoxin (87). 

Nifedipine, verapamil, and diltiazem are all efficacious in the treatment of mild and moderate hypertension, but nifedipine is more efficacious than diltiazem and verapamil in the control of severe hypertension. Nifedipine does not cause significant reflex tachycardia or orthostatic hypotension. Nifedipine benefits the older and black patients and patients with low PRA. 

Nifedipine (Table 3) is a potent vasodilator that selectively dilates resistance vessels and has fewer effects on venous vessels. It does not cause reflex tachycardia during chronic therapy. Nifedipine is one of the first-line choices for black or elderly patients and patients having concomitant angina pectoris, diabetes, or peripheral vascular diseases. Nifedipine, sublingually, is also suitable for the treatment of hypertensive emergencies. Nifedipine does not impair sexual function or worsen blood Hpid profile. The side effects are flushing, headache, and dizziness. 

Bradycardia Bradycardia is a slow heart rate (60 beats per minute or slower) that does not meet the body s metabolic demands. Symptoms of bradycardia include dizziness, extreme fatigue, shortness of breath, or fainting spells. This can be compared to tachycardia, which is an extremely rapid heart rate, usually signified by a pulse of over 100 beats per minute. Adults usually have a resting heart rate of 70-80 beats per minute, although well-trained athletes can have resting rates in the 50 s or 60 s. Newborn babies have a normal heart rate of 120-160 beats per minute. A slowed heart rate can lead to a variety of other problems. First aid treatment may include administration of oxygen. 

Presently, only adenosine itself is approved for clinical use. It is used widely in the treatment of supraventricular tachycardia and in cardiac stress imaging to assess coronary artery disease [5]. Other agonists and antagonists and an allosteric modulator of the Ai receptor are in clinical trials for a variety of indications. 

Hyperthyroidism (thyrotoxicosis), defined as excessive thyroid activity, causes a state of thyroid hormone excess (thyrotoxicosis) characterized by an increased metabolic rate, increase in body temperature, sweating, tachycardia, tremor, nervousness, increased appetite and loss of weight. Common causes of hyperthyroidism are toxic multinodular goiter, toxic adenoma or diffuse toxic goitre ( Graves disease). Antithyroid diugs (methimazol, carbimazole, propylthiouracil) block thyroid hormone production and are hence suitable for the treatment of hyperthyroidism. 

PI (adenosine) receptors were explored as therapeutic targets before P2 receptors. Adenosine was identified early and is in current use to treat supraventricular tachycardia. A2a receptor antagonists are being investigated for the treatment of Parkinson s disease and patents have been lodged for the application of PI receptor subtype agonists and antagonists for myocardial ischaemia and reperfusion injury, cerebral ischaemia, stroke, intermittent claudication and renal insufficiency. 

These dm are primarily used in the treatment of hypertension (see the Summary Drug Table Adrenergic Blocking Drugs also see Chap. 39) and certain cardiac arrhythmias (abnormal rhythm of the heart), such as ventricular arrhythmias or supraventricular tachycardia They are used to prevent reinfarction in patients with a recent myocardial infarction (1—4 weeks after MI). Some of these dm have additional uses, such as the use of propranolol for migraine headaches and nadolol for angina pectoris. 

Epoetin alfa (erythropoietin EPO) and darbepoetin alfa are usually well tolerated. The most common adverse reactions include hypertension, headache, tachycardia, nausea, vomiting, diarrhea, skin rashes, fever, myalgia, and skin reaction at tlie injection site. See the Summary Drug Table Drug Used in the Treatment of Anemia for more information on these drug. 

The patient with hyperthyroidism is likely to have cardiac symptoms such as tachycardia or palpitations. Propranolol, a adrenergic blocking drug (see Chap. 21), may be prescribed by tlie primary health care provider as adjunctive treatment for several weeks until tlie therapeutic effects of tlie antithyroid drug are obtained. 

---