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block conversion of angiotensin I to II (inhibits ACEI activity) Makes it so bradykinin cannot be inactivated
Lisinopril
Indication: first line for HTN, HFrEF, secondary prevention of CAD, kidney disease
Side effects: dry cough, hypotension, hyperkalemia, acute renal failure, DO NOT USE IN PREGNANCY (D), renovascular HTN, angioedema (ludwig's angina), lung cancer risk Hydrochlorothiazide (HCTZ)
Works on early distal tube and blocks the Cl pump. Reduces PVR and causes vasodilation
Indications: First-line for HTN
Side effects: hypokalemia, caution with DM, decreased Na+, decreased potassium, increased calcium, Don't use in pregnancy
thirst, muscle cramps, dizziness, renal dysfunction, hyperuricemia, adverse lipids
Don't give doses over 50mg or with K-sparing diuretics Furosemide (Lasix)
Works on thick ascending loop of Henle, blocks the Cl pump. MOST POTENT diuretic effects
Indications: Heart failure, edema
Side effects: Increased urination, ototoxicity, decreased potassium, Don't use in pregnancy
increased thirst, muscle cramps, dizziness, renal dysfunction, hyperuricemia, adverse lipids Depolarization is coming from SA node (p waves present), but occurring more slowly (<60)
Non-pathologic:
increased vagal tone in athletes, common in elderly, during sleep
pathologic:
Sinus node dysfunction, medication side effects, MI, hypothyroidism, infection
Symptoms:
Most are asymptomatic
IF symptomatic: fatigue, lightheadedness, dyspnea, presyncope, syncope
Diagnosis: EKG
Treatment: ONLY if symptomatic, but treat the underlying condition
TREAT is symptomatic and hemodynamically unstable depolarization is coming from SA node but more quickly.
P waves can be partially hidden in T waves
Non-pathologic: exercise, fear excitement
Pathologic: fear/infection, pain, hypoxia, hypovolemia, anemia, hyperthyroidism, meds/drugs
Doesn't usually cause symptoms
Most symptoms come from what is causing the tachycardia (pain, fever, SOB, etc.)
Confirm with EKG
Look for and treat cause Variety of presentations from mind/no symptoms to:
heart failure, MI, stroke, HD collapse
Common symptoms:
fatigue, palpitations, angina, syncope, dizziness, dyspnea, orthopnea
Diagnosis:
-irregularly irregular pulse, but should be confirmed with EKG. Normal EKG doesn't rule out as it could be paroxysmal (use holter monitor)
-Labs (check for underlying cause)
-TTE (structure and function)
-x-ray (check for pulmonary dz) Early ectopic beats in or near AV junction
QRS will resemble normal morphology
P waves will be absent, inverted, or retrograde (travel backwards from AV junction towards atria)
Cause: hypokalemia, digoxin toxicity, lung disease, MI, stimulants, stress, valvular disease, pericarditis, HF, hyperthyroid, etc. 