Arrhythmias
(A) Sinus arrhythmias
Tachycardia
Prescription: Atenolol (aminoglutethimide) 12.2~25mg bid or tid
or Metoprolol 12.2~25mg bid or tid Liu Yanhua, Department of Cardiology, General Hospital, Eastern Hospital Group, Huainan City, Anhui Province
Bradycardia
Prescription I: Atropine 0.3mg tid
Prescription two: Aminophylline controlled release (Shuflumet) 0.1~0.2 bid
Prescription three: ephedrine 12.5~25mg bid or tid
Prescription IV: Isoproterenol 5mg with dose every 3~4 hours
(ii) Premature beats
Premature atrial contractions (generally untreated, but treated if excessive)
Prescription: Verapamil (Isoptin) 40~80mg tid
Extended release verapamil 120~240mg qd
Premature ventricular movement
10% glucose 20ml
Intravenous push
Lidocaine 50~100mg
Followed by 10% dextrose 500ml
IV
Lidocaine 800~1000mg
After 1~2 days, change to: Metoprolol 12.5~25mg bid
Methicillin (slow heart rhythm) 0.1~0.2 tid
Or Methicillin (slow heart rhythm) 0.2g po followed by 0.05~0.1 tid
or Propafenone (cardioplegia) 0.1~0.2 tid
or Maurethizine (ethomorphine) 70mg tid
(C) Paroxysmal supraventricular tachycardia
Prescription 1: 10% glucose 20ml
Intravenous Push Slow!
Verapamil (Isoptin) 5mg
Prescription 2: 10% dextrose 20ml
Push slowly!
Propafenone 70mg
(iv) Paroxysmal ventricular tachycardia
Prescription: first lidocaine (use the same as ventricular premature)
If ineffective, switch to: Amiodarone 150mg slowly sedated, then titrated for maintenance, 1mg per minute for the first 6 hours. 0.5mg per minute thereafter
5% dextrose 500ml
IV Slowly! (5~10mg per minute, total amount not more than 1-2g)
Procainamide 0.5~1mg
Due to digitalis poisoning: 10% dextrose 20ml
IV push, 5 minutes to finish
Phenytoin sodium 100mg
(E) Atrial flutter and atrial fibrillation
1.Control of heart rate
For those who do not have preexcitation syndrome and have not used digitalis in the past 2 weeks
Prescription: 50% glucose 20ml
Push intravenously, slowly!
Trichosanthin C 0.4mg
Switch to digoxin 0.25mg qd after the heart rate is controlled below 100 beats/min
2.Retroduction of persistent atrial fibrillation
When the ventricular rate is stabilized at 70~80 beats/min by the above methods, stop digitalis and resuscitate with quinidine or acetamidofurone or synchronous direct current
Prescription 1: Quinidine 0.2 tid (now used sparingly)
Prescription 2: Amiodarone (ethamioduroxone) 0.2 tid
Note: The above two drugs have significant toxic side effects and should be used with caution. If there is a decrease in blood pressure, prolongation of QRS wave group time limit by 25% or more, premature ventricular contractions or significant prolongation of Q-T interval such as ≥0.48s, the drug should be stopped or reduced immediately.
Prescription 3: Sotalol 80mg bid
(F) Atrioventricular block
Prescription: Atropine 0.3mg tid
Isoproterenol 5~10mg 4 times/day
Rheumatic fever
(1) Bed rest
(2) Prescription 1: Penicillin 80WU im bid
Prescription 2: Erythromycin 0.375g tid 【Children 40mg/(kg*d)
(3) Prescription 1: Aspirin 0.6~1.2g tid 【Children 0.08~0.1g/(kg*d)
Prescription 2: Prednisone 30~40mg qd maintain until symptom control, gradually reduce the dosage, the course of treatment 3~6 months or longer
Note: To reduce the recurrence of rheumatic fever, benzathine penicillin (long-acting) 60WU (less than 6 years old)~120WU (more than 6 years old) should be given im once/month. Erythromycin 0.25 bid for allergy, or sulfasalazine 0.5 (children <30KG) ~ 1.0 (≥30KG and adults) per day, shared for 1-2 days.
Chronic rheumatic heart valve disease
Prescription Avoid strain and stress
Penicillin 160WU
Intravenous push bid
Physiological saline 20ml
Change to long-acting penicillin intramuscular injection after 5-7 days, once a month.
Aspirin 0.9 tid
(I) Mitral valve stenosis
1.Acute pulmonary edema
(1) Oxygen administration
(2) Morphine 3~5mg intravenously
(3) 10% glucose 20ml
Intravenous injection
Furosemide 20mg
(4) ********0.5mg sublingually every 5-10 minutes, discontinue if systolic blood pressure drops to 90mmhg or less
(5) 5% dextrose 500ml
Intravenous drip (6~8 drops/min Start)
Sodium nitroprusside 25~50mg
(6) 10% dextrose 20ml
Intravenous push Slowly!
Trichosanthin C 0.4mg
(II) Aortic valve insufficiency
Prescription: low salt diet
Isosorbide (isosorbide nitrate, cardiac pain relief) 10mg tid
Nitrendipine 10mg tid
Captopril 12.5~25mg bid or tid