0071643192.pdf

■ Nicardipene

■ Calcium channel blocker

■ ↓Peripheral vascular resistance

■ ↓Cerebral vasospasm (good for stroke syndromes)

■ Nitroglycerin

■ Venous >>arteriolar dilation

■ Labetalol

■ α 1 -,β-Adrenergic blocker

■ Much more β-blockade than α-blockade

■ Effective as single agent

■ Esmolol

■ β 1 -Adrenergic blocker

■ Very short acting

■ Often used with nitroprusside to blunt tachycardia

■ Hydralazine

■ Direct arteriolar vasodilator (watch for reflex tachycardia)

■ Phentolamine

■ Pureα-blocker

CARDIOVASCULAR TESTING

The following summary briefly reviews some of the common modalities used

to further delineate primary cardiovascular disorders. It is not a comprehen-

sive source but rather covers key points pertinent to the ED physician’s man-

agement of patients with cardiovascular diseases.

ECHOCARDIOGRAM

■ Transthoracic echo (TTE)

■ Evaluates ventricular size and function

■ Identifies valvular pathology

■ Detects effusions and tamponade physiology

■ Stress echo identifies areas of hypokinesis, akinesis, or dyskinesis during

exercise or pharmacologic stress tests.

■ Transesophageal echo (TEE)

■ Due to placement in the esophagus, more detailed studies can be

obtained.

■ Identifies mural thrombi prior to cardioversion

■ Higher sensitivity than TTE in detecting aortic dissection

■ More invasive and technically more difficult than TTE

HOLTERMONITORING

■ Ambulatory ECG monitor that records dysrhythmias and other pathologies

■ Correlated with patient’s diary of symptoms

■ An event recorder allows the patient to activate the recorder at the onset of

symptoms.

TILT-TABLETESTING

■ Used to evaluate patients with suspected vasovagal syncope

■ Goal is to provoke syncope while patient is monitored.

■ As table tilts, blood pools in LE venous system.

■ Venous return ↓

■ Myocardial contraction to compensate

↓

CARDIOVASCULAR EMERGENCIES