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cardiovascular diseases
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Definition
THE TREATMENT 1 - Goal It is proper to distinguish the acute treatment, and the long-term treatment of the illness. 2 - Means - Medical treatment
The isoprenaline (Isuprel®) is prescribed in the dose of 0.2 to 10mg/day, in practice 5 phials in 250cc G5% with an electric push-syringe (EPS)*, a dose to adapt to the efficacy. In case of an urgent situation, the subcutaneous way can be used. The surveillance of the heart activity and of the B.P. is obligatory. * (N.d.T. : An electric device to infuse by i.v. very powerful substances). - Implantation of a pacemaker 3 modes of increasing sophistication stimulation are used: - The ventricular monochamber mode or VVI, which detects the ventricular activity and if apause occurs, stimulates the ventricle in a programmable but invariable frequency, - The ventricular monochamber mode with a “ServoFrequency”or VVI-R adapts the stimulation frequency to the variations of a biologic signal as the respiratory frequency, the temperature... giving a reliable indicator of the subject’s activity. The adaptation to the exercise is quasi-physiological. - The dual chamber mode or VDD-DDD is linked to 2 electrodes, atrial and ventricular. It detects the spontaneous atrial activity then starts up a ventricular stimulation with a variable atrioventricular delay. 3 - Indications
a - Treatment of a cardiac arrest Punching the sternum permits in most cases to restart the cardiac activity. In the contrary case, the concomitant external cardiac massage and ventilation are required. The electrostimulation is indicated afterwards, with a training probe at the level of the right ventricle, or by electric stimulation of the heart through the thoracic wall. b - Treatment of a tachycardia These tachycardias are spontaneously resolvent in the majority of the cases. A prolonged access or the transformation into ventricular fibrillation requires a fast external electric shock. The prevention of the recidivations is based on a temporary electrostimulation while waiting for the efficacy of the intravenous infusion of isoprenaline (Isuprel®), which accelerates the heart rhythm. c - Treatment of an acute atrioventricular block: temporary electrostimulation (temporary pacemaker) The temporary electrostimulation cannot be discussed in the high degree atrioventricular blocks, the atrioventricular blocks on an antero-septal myocardial infarction and the ones, which are ill-tolerated. d - Treatment of an atrioventricular chronic block: definitive electrostimulation (implantation of a pacemaker) if an of cause and effect relationship has been established. The 2nd degree atrioventricular blocks associated to symptoms, and all 3rd degree atrioventricular blocks are a matter for a definitive electrostimulation. In the other cases, therapeutic abstention is a rule. Choosing the stimulation mode is a function of the ground, of the paroxysmal or permanent feature of the atrioventricular block, the atrial activity and a possible associated illness of the heart: - VVI simple atrioventricular paroxysmal block and slow escape rhythm - VVI-R atrioventricular block and atrial fibrillation or high degree atrial fibrillation on a healthy heart - VDD-DDD high degree atrioventricular block on a pathological heart if the sinusal function is kept. 4 - Results The regression of the symptoms, the improvement or the stabilization of a cardiac insufficiency and the cancelling of a sudden death risk are observed. 5 - Monitoring It is done at regular intervals by the cardiologist who prescribed and the one
who implanted the pacemaker: the first insures that the cardiac illness or the
causal factor is well-balanced or reduced; the other insures that the pacemaker
functions well. The change of the pacemaker is made at regular intervals depending
on the longevity of the battery.
File last reviewed on dec 18, 2011 |
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