Premature atrial complexes (PACs) are something I’ve explained to trainees and patients for years, but about a week ago, I started having them following a really rough stretch in the CVICU. As a cardiac anesthesiologist and intensivist, I know how common PACs are and how often they are benign, but…
As a cardiothoracic anesthesiologist and intensivist, many of my patients receive ventricular pacing at some point during their hospital admission. In the OR, many patients have epicardial right ventricular (RV) pacing implanted following cardiac surgery. In the ICU, I often encounter transvenous pacing (TVP) of the RV. Remember, normal cardiac…
Procainamide is a type IA antiarrhythmic which prolongs repolarization via sodium channel blockade. This is achieved by slowing conduction through the ventricular His-Purkinje system thereby widening the QRS complex (and ultimately the QT interval).
With the number of patients receiving permanent pacemakers (PPMs) and implantable cardioverter-defibrillators (ICDs) increasing each year, we’ll see more of these devices in our respective clinical settings. With this post, I’ll try to simplify pacemaker nomenclature and discuss some of the considerations surrounding magnets and device settings.
Adenosine is a nucleoside that forms the backbone for energy substrates like ATP and signal transduction/second messenger systems like cyclic AMP. Clinically, it converts supraventricular tachycardias that involve the atrioventricular (AV) node like certain AV reentrant and AV nodal reentrant tachycardias. Adenosine transiently blocks the AV node via inhibition of…
Amiodarone (Pacerone) is an antiarrhythmic that works by prolonging the myocardium’s refractory period through potassium channel, sodium channel, calcium channel, and beta-blockade. Its side effects can be remembered by their effects on “PFTs, TFTs, and LFTs” (pulmonary, thyroid, and liver testing, respectively) in addition to corneal, neurological, and skin changes.
Lidocaine (Xylocaine) is an amide local anesthetic I use all the time for procedures ranging from line and chest tube placement to peripheral nerve blocks and awake fiberoptic intubations. It works by moving into nerve cells to block voltage-gated sodium channels which are normally responsible for creating an influx of…