Calcium channel blockers for stable SVT: A first line agent over adenosine?

A 52-year old man presents via EMS with a chief complaint of “racing heartbeat” for one hour. He is placed on a cardiac monitor which shows a heart rate of 185, an ECG reveals supraventricular tachycardia (SVT), and his blood pressure is 143/95 mmHg. As you ask the nurse to procure 6 mg of adenosine, the patient’s eyes grow wide.

“Please doc…” he pleads, “anything but that! Last time they gave that to me I thought I was gonna die!”

You recently read about using calcium channel blockers (CCBs) for paroxysmal SVT (PSVT), but can’t recall the last time you actually considered using them. After all, it’s been over 20 years since we switched to using adenosine first-line.

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By Stephen Rappaport, PharmD, BCPS|2024-01-12T02:08:09-08:00Mar 23, 2016|Cardiovascular, Expert Peer Reviewed (Clinical), Tox & Medications|

PEM Pearls: Cardiac causes of pediatric chest pain

Children with chest pain commonly present to the emergency department. Both the child and family members may think their symptoms are due to a serious illness. Among adolescents seen for their chest pain, more than 50% thought they were having a heart attack or that they had cancer.¹ In reality, only 6% of pediatric chest pain has a cardiac etiology.² Nonetheless, extensive and costly emergency department (ED) evaluations are common and there is wide practice variation.³

But prior to reassuring your patient, what can you do to reassure yourself that your patient doesn’t need a more extensive workup? What would make you suspicious for cardiac causes of pediatric chest pain?

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By Delphine Huang, MD|2017-10-26T14:34:30-07:00Dec 14, 2015|Cardiovascular, CME, Pediatrics, PEM Pearls|

Ultrasound For the Win! Case – 55-year-old man with chest pain #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this peer-reviewed case series, we focus on real clinical cases where bedside ultrasound changed management or aided in diagnoses. In this case, a 55-year-old man presents with acute-onset chest pain.

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By Jeffrey Shih, MD, RDMS|2017-07-19T00:06:58-07:00Dec 9, 2015|Cardiovascular, Ultrasound, Ultrasound for the Win|

Highlights from the 2015 American Heart Association CPR and ECC guidelines

The newest round of the 2015 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) contains 315 recommendations.¹ It is easy to be overwhelmed by this massive (275 pages) document so this post will distill what you need to know in the emergency department. This update marks the end of a 5-year revision cycle for the AHA and the shift to a continuously updated model. Current and future guidelines can now be found at ECCGuidelines.heart.org. This round lacks any of the major foundational changes seen in 2010; however, we do say goodbye to some recommendations (bye bye vasopressin).

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By Sean Kivlehan, MD MPH|2019-09-05T20:30:15-07:00Nov 9, 2015|Cardiovascular, CME, Critical Care/ Resus, Guideline Review|

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

For many years, end tidal CO2 monitoring initially was helpful in differentiating tracheal versus esophageal intubations. Now with continuous end tidal capnography, providers have access to so much more information during a cardiac arrest resuscitation, as summarized by the recently released 2015 American Heart Association (AHA) recommendations.¹ Thanks to Dr. Abdullah Bakhsh from Emory University for a great PV card to help remind us of these key cardiac resuscitation pearls.

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

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Adapted from [1-4]

References

Link M, Berkow L, Kudenchuk P, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64. [PubMed]
Ahrens T, Schallom L, Bettorf K, et al. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care. 2001;10(6):391-398. [PubMed]
Silvestri S, Ralls G, Krauss B, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005;45(5):497-503. [PubMed]
Kleinman M, Brennan E, Goldberger Z, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S414-35. [PubMed]

By Michelle Lin, MD|2021-10-19T19:25:31-07:00Oct 20, 2015|ALiEM Cards, Cardiovascular, Critical Care/ Resus|

AIR Series: Cardiology – CHF, PVD, and Others (part 2)

As mentioned last module, the FOAMsphere contains a phenomenal amount of cardiology content. Accordingly, the CORD testing schedule and our cardiology module has been divided into two parts. Below we have listed our selection of the 12 highest quality blog posts within the past 12 months (as of August 2015) related to acute coronary syndromes, curated and approved for residency training by the AIR Series Board. In this module we have 6 AIRs and 6 Honorable Mentions. We strive for comprehensiveness by selecting from a broad spectrum of blogs from the top 50 listing per the Social Media Index.

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By Andrew Grock, MD|2017-03-05T14:14:16-08:00Oct 12, 2015|Approved Instructional Resources (AIR series), Cardiovascular|

AIR-Pro Series: Cardiovascular (2015)

Below we have listed our selection of the 8 highest quality blog posts related to 3 advanced level questions on cardiovascular topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions:

Advanced concepts about Sgarbossa’s Criteria
Troubleshooting pacemaker’s and automated implantable cardioverter defibrillators (AICD’s)
Troubleshooting left ventricular assist devices (LVAD’s)

In this module, we have 5 AIR-Pro’s and 3 Honorable Mentions. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net.

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By Fareen Zaver, MD|2017-01-20T12:32:51-08:00Sep 21, 2015|Approved Instructional Resources PRO (AIR-Pro Series), Cardiovascular|

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