smal
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in a pt with MI with CCF,which is the appropiate first drug?
1. digoxine
2.tissue plasminogen activator?
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| ManuNastai
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CCF? do you mean CHF (congestive heart failure)?
tPA if it's less than 6 hours, after that you'll end up with free radical damage to it and digoxin if it's safe
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| ManuNastai
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I understand that digoxin is not considered to be given any more if you got a synusal rhitm 'cause it's dangerous.
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"Love is the only inflamation of the heart that drains in the vagina" (translation after Dr Petre Florescu, Professor of Pathology, UMF "Iuliu Hatieganu", Cluj Napoca
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| smal
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but is not digoxine given to increase cardiac contractility in CCF......ya CHF
i didnt know that its not used now-a-days.
thanks again!
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| ManuNastai
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yes it is used. is not used if you got a synusal rhitm (ie. if it's not atrial fibrilation).. in AMI with signs of CHF and atrial fibrilation you put him on Digitalis by all means..
also, i know (but not very sure) that after the acute phase has passed you put him on beta blockers paradoxically, 'cause it has been demonstrated that it prolonges life, thing that hasn't been demonstrated with digoxin
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"Love is the only inflamation of the heart that drains in the vagina" (translation after Dr Petre Florescu, Professor of Pathology, UMF "Iuliu Hatieganu", Cluj Napoca
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| smal
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i thought its ACE+ spironolactone?
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remedy for weakness is not brooding over it ,but thinking of strength.
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| smal
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ya u r rt,
b-blockers too
can u plz tell which B blocker can be given in such situations?
i think any B-blocker with ISA is contraindicated(dont exactly remember)
one that can be given r -metoprolol,carvedilol.
Edited by smal on 11/12/06 - 12:23 PM
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| ManuNastai
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ok..
in heart failure you wanna increase the power of the heart, so you give digoxin (if you can).. you wanna decrease both the preload and afterload so you administer a vasodilator and ACE inh which have been demonstrated to have a pozitive effect on myocites following MI and in CHF.. you also administer a diuretic
now, besides tose above if you have an acute CHF, like in our case, following AMI, you wanna give a positive inotropic drug, beta agonist ([/b]isoproterenol[/b]) or a PDE inhibitor and furosemide 'cause it acts better in acute stuff (ACHF, APE etc) and if you have a cronic CHF (like following long ischemic heart disease), you give the K+ sparring diuretics and also a beta blocker
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"Love is the only inflamation of the heart that drains in the vagina" (translation after Dr Petre Florescu, Professor of Pathology, UMF "Iuliu Hatieganu", Cluj Napoca
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| smal
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thanks that was very elaborate.but i wanted to know WHICH betablockers could be given.
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remedy for weakness is not brooding over it ,but thinking of strength.
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| ManuNastai
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 that I don't know..
I don't think there's one best.. and then again maybe there is.. but I guess selective beta 1 blockers are better
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"Love is the only inflamation of the heart that drains in the vagina" (translation after Dr Petre Florescu, Professor of Pathology, UMF "Iuliu Hatieganu", Cluj Napoca
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