ACLS Protocols

As a senior internal medicine resident on night float and overnight call, I’m responsible for running to codes and rapid responses.  Rapid responses at my institution are critical patient situations that require urgent bedside attention for things like symptomatic supraventricular tachycardia, new typical chest pain, hemodynamic instability, etc.  Today after work, I wanted to brush up…

HFpEF Treatment

These patients tend to be very VOLUME SENSITIVE. Daily weight checks – get an accurate bathroom scale. No medications have proven mortality benefit. Treat causes Hypertension – lower the patient’s blood pressure Tachycardia – AV nodal blockade depending on etiology.   Bibliography ACP MKSAP 17:  Cardiovascular Medicine, pp. 32-34 Image credit (follow link)

HFrEF Medical Treatment

Heart Failure with Reduced Ejection Fraction (also known as systolic heart failure) is broken up into two phases of treatment:  the acute (on presentation to the hospital) and chronic (long-term to prevent re-hospitalization). Acute Exacerbation Treatment DIURETIC (urinate off all the excess fluid in a volume-overloaded patient) ACE inhibitor or Angiotensin Receptor Blocker (ARB) contraindicated if…

Heart Failure Pathophysiology and Diagnosis

Pathophysiology In an average healthy person, normal LV ejection fraction (LVEF):  >50% Roughly 50% of those with heart failure have reduced left ventricular (LV) function (HFrEF) Heart cannot squeeze/contract properly, and then progressively dilates. The other 50% have preserved (normal contraction) LV function (HFpEF) Cannot relax properly, leading to high diastolic (filling) pressures. New heart failure…

Atrial Flutter

More organized, saw-tooth type pattern seen on standard 12-lead EKG. Negative flutter waves in inferior leads Positive flutter waves in V1 Typical Flutter = counterclockwise reentry around tricuspid annulus. Rate is ~250/min; noted as 2:1 or 4:1 for its atrial rate and the ratio of electrical conduction down the AV node. Atrial Flutter is often seen in…

Atrial Fibrillation

As of the time of this writing, I am a second-year internal medicine resident physician, and have been involved in the care of at least fifty patients (averaging nearly one patient per work week, a very conservative estimate) with Atrial Fibrillation (AFib), an abnormal heart rhythm.  According to MKSAP 17 Cardiovascular Medicine, it is the #1…