Cardiotonic agents

Chemical actions and uses: Cardiovascular agents

Also known as

• Cardiac stimulants
• Cardioprotective agents
• Cardiotonic drugs
• Cardiotonics
• Positive inotropic agents
• Cardiac myocardial stimulants

Do not confuse with:

• Negative inotropic agents

 

Uses

• Myocardial infarct
• Cardiac surgical procedures
• Shock
• Congestive heart failure

 

Examples

• Cardiac glycosides
• Digoxin
• Calcium sensitisers
• Levosimendan
• Sympathomimetics
• Epinephrine 
• Norepinephrine
• Dopamine
• Dobutamine 
• Isoprenaline
• Phosphodiesterase inhibitors  
• Enoximone
• Milrinone
• Amrinone
• Theophylline
• Other agents
• Prostaglandins
• Angiotensin II
• Glucagon
• Insulin

 

See also

• Vasoconstrictor agents
• Vasodilator agents

Vasoconstrictor agents

Chemical actions and uses: Cardiovascular agents

Also known as

• Vasoactive agonists
• Vasoconstrictor drugs
• Vasoconstrictors
• Vasopressor agents 

Uses

• Myocardial infarct
• Cardiac surgical procedures
• Shock
• Congestive heart failure

 

Examples

Pure vasoconstrictors

• Phenylephrine
• Vasopressin

Vasoconstrictors + Inotropes

• Sympathomimetics
• Norepinephrine
• Epinephrine 
• Dopamine

 

See also 

• Cardiotonic agents (positive inotropes)
• Vasodilator agents

Vasodilator agents

Chemical actions and uses: Cardiovascular agents

Also known as

• Vasoactive antagonists 
• Vasodilator drugs 
• Vasodilators 
• Vasorelaxants

 

Indications

• Angina pectoris
• Hypertension
• Cardiac surgical procedures
• Shock
• Congestive heart failure

 

Examples

• Sympathomimetics
• Dobutamine
• Isoprenaline

• Phosphodiesterase inhibitors  
• Milrinone 
• Amrinone 

Other agents

• Angiotensin-Converting Enzyme (ACE) inhibitors 
• Captopril
• Enalapril
• Angiotensin II receptor blockers (ARBs) 
• Alpha adrenergic blockers
• Prazosin
• Trimazosin
• Calcium channel blockers (CCBs) 
• Nifedipine
• Verapamil
• Diltiazem
• Hydralazine
• Minoxidil
• Nitrates
• Glyceryl Trinitrate (GTN, nitroglycerin)
• Nitroprusside (SNP)
• Isosorbide Dinitrate (ISDN)

 

See also 

• Vasoconstrictor agents
• Cardiotonic agents (positive inotropes)

Mediastinitis

Disease class: Mediastinal diseases

[Cardiothoracic surgery] Introduction

Cardiothoracic surgeons specialise in diseases of the heart, lungs, and thoracic cavity.
There is significant overlap with cardiology and pulmonology.

 

Etymology

Ancient Greek καρδίᾱ (kardiā) = heart

Ancient Greek θώραξ (thṓrax) = thorax
Ancient Greek θωρακικός (thōrakikós) = of the thorax

 

History taking

Physical examination  

 

Common problems:

• Heart valve disease
• Bicuspid aortic valve  
• Mitral stenosis 
• Mitral insufficiency (mitral regurgitation)
• Aortic stenosis
• Aortic insufficiency (aortic regurtitation)
• Pericardial effusion
• Cardiac tamponade
• Congenital heart disease
• Chronic obstructive pulmonary disease
• Lung cancer

 

Heart diseases

 

Lung diseases

 

Diseases:

• Mitral valve prolapse
• Mesothelioma 
• Myxoma
• Thymoma 
• Aortic coarctation
• Patent ductus arteriosus 
• Tetralogy of Fallot
• Transposition of the great vessels
• Ventricular septal defect (VSD) 
• Eisenmenger's syndrome 

Funnel chest

Disease class:  bone diseases, Developmental

Pectus carinatum

Disease class:  bone diseases, Developmental

Pleuritis

Disease class: Pleural diseases 

Disease class: Respiratory tract infections

Also known as

• Pleurisy

Symptoms

• Pleuritic chest pain (worse on breathing)

 

Signs

• Auscultation: Pleural rub

 

Aetiology / Causes

• Bornholm disease (Coxsackie B virus infection)

Aortic rupture

Disease class: Ruptured aneurysm

Brugada syndrome

Disease class: Cardiac conduction system disease

Brugada syndrome is a form of inherited cardiovascular disease with may present with sudden cardiac death. It is inherited in an autosomal dominant fashion and has an estimated prevalence of 1:5,000-10,000. Brugada syndrome is more common in Asians.

 

Pathophysiology

• a large number of variants exist
• around 20-40% of cases are caused by a mutation in the SCN5A gene which encodes the myocardial sodium ion channel protein

 

ECG changes

• convex ST segment elevation > 2mm in > 1 of V1-V3 followed by a negative T wave
• partial right bundle branch block
• changes may be more apparent following flecainide

ECG showing Brugada pattern, most marked in V1, which has an incomplete RBBB, a downsloping ST segment and an inverted T wave

 

Management

• implantable cardioverter-defibrillator

 

Complications

• Sudden cardiac death 

Flail chest

Thoracic injuries

 

Cardiac conduction system disease

Disease class: Heart diseases

Types

• Brugada syndrome
• cardiac complexes, Premature
• Heart block
• Long QT syndrome
• Pre-excitation syndromes
• Tachycardia

Endocarditis

Disease class: Heart diseases

Types

• endocarditis, Bacterial
• endocarditis, Non-infective

Rheumatic fever

Disease class: Rheumatic diseases

Pulmonary heart disease

Disease class: Heart diseases

Also known as cor pulmonale.

 

Causes

• Chronic obstructive pulmonary disease

Acute coronary syndrome

This is a type of disease caused by myocardial ischaemia.

Infected aneurysm

Disease class: Aneurysm

Disease class: Infection

Commonly known as mycotic aneurysm.
This refers to an infection of an arterial wall.

 

Causes

• Infective endocarditis
• Post-operative (cardiothoracic) infections 

 

Pathophysiology

Infectious agents penetrate the innermost layer of an artery and grow, forming an aneurysm.

When this is secondary to IE, there are likely to be many aneurysms around the circulatory system. As many as 15% to 29% of patients with IE have neurologic symptoms. IE may be responsible 2.6% of aortic aneurysms.

 

Causative organisms

• Commonly bacteria
• Rarely fungal

Investigations

On imaging, the aneurysm may appear 'mushroom-shaped' (this is the only reason why it is known as 'mycotic' aneurysm).

Complications

• Haemorrhage
• Sepsis

 

Management 

• Antibiotic therapy
• Surgical resection
• Surgical removal of infectious source

Bacterial endocarditis

Disease class: Endocarditis

This refers to infective inflammation of the heart valves.

 

Complications

• Infected aneurysm

 

Management

• Aminoglycosides
• Penicillins
• Penicillins, penicillinase-resistant
• Vancomycin

Hypertrophic cardiomyopathy

Also known as HCM.

Mitral stenosis

Disease class: Heart valve disease