Atrial fibrillation (AF) is diagnosed as an abnormal rhythm of the heart. A heart without atrial fibrillation contracts and pumps blood at a regular rhythm such as at a rate of 60 beats per minute. While the heart may beat faster or slower with a shorter or longer interval between beats it maintains a constant interval at any one rate through regular electrical discharges, or currents, that travel through the heart and cause the muscle of the heart to contract. In people with AF, the electrical discharges are irregular and rapid and, as a result, the heart beats irregularly and, usually, rapidly. This is a common disorder that affects over half a million people yearly in the United States.
Commonly Prescribed (On-Label) Drugs: Digitoxin, Dofetilide, Flecinide, Heparin, Verapamil, Warfarin
Off-Label Prescription Drug Breakthrough Option: Amiodarone
Supraventricular arrhythmias happen in the upper chambers of the heart. Generally, supraventricular or “atrial arrhythmias” are not as serious as ventricular arrhythmias. Sometimes, they do not even require treatment. Atrial arrhythmias can happen in response to a number of things, including tobacco, alcohol, caffeine, and cough or cold medicines. The disorder also may result from rheumatic heart disease or an overactive thyroid (hyperthyroidism).
Commonly Prescribed (On-Label) Drugs: Propafenone
Off-Label Prescription Drug Breakthrough Option: Atenolol
Supraventricular tachycardia (SVT) is a general term describing any rapid heart rate originating above the ventricles or lower chambers of the heart. SVT is an arrhythmia or abnormal heart rhythm. Specific types of SVT include: atrial fibrillation, AV nodal re-entrant tachycardia, and Wolff-Parkinson-White syndrome.
SVT generally begins and ends quickly. You may experience short periods of SVT and have no symptoms. However, SVT becomes a problem when it occurs frequently or lasts for long periods of time and produces symptoms. Common symptoms associated with SVT include palpitations, light-headedness, and chest pain. SVT may also cause confusion or loss of consciousness.
Commonly Prescribed (On-Label) Drugs: Adenosine, Flecainide, Methoxamine
Off-Label Prescription Drug Breakthrough Option: Atenolol
Torsades de Pointes is a cardiac arrhythmia that may cause blackouts or even sudden death. The phrase “Torsades de Pointes” is French and literally means “twisting of the points,” referring to the characteristic appearance of the electrocardiogram (ECG) during the rhythm abnormality. Torsades de Pointes occurs in individuals with genetic mutations in their genes that control sodium or potassium channels and is a frequent cause of sudden death in these individuals. It also occurs as a complication of drugs that prolong the QT interval (the interval that represents the time for electrical activation and inactivation of the heart’s ventricles) by blockade of potassium channels. Doctors measure the time it takes for the QT interval to occur (in fractions of a second). By measuring the QT interval, they can determine it occurs in a normal amount of time, or it takes longer, which is then called a prolonged QT.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drug Breakthrough Option: Magnesium Sulfate
Ventricular tachycardia is a rapid heartbeat initiated within the ventricles (chambers that collect blood and then pump it out of the heart), characterized by three or more consecutive premature ventricular beats. Ventricular tachycardia is a potentially lethal disruption of normal heartbeat (arrhythmia) that may cause the heart to become unable to pump adequate blood through the body. The heart rate maybe 160 to 240 (normal is 60 to 100 beats per minute). Ventricular tachycardia occurs in approximately two out of 10,000 people.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Atenolol, Magnesium Sulfate, Metoprolol, Phenytoin, Verapamil
Ventricular tachycardia (VT), usually defined as more than three consecutive electrocardiographic (ECG) complexes of ventricular origin at a rate of more than 100 beats/min, varies widely in severity. The vast majority of people with tachycardia and heart disease have VT.
Off-Label Prescription Drugs Breakthrough Options: Atenolol, Bisoprolol, Carvedilol, Metoprolol, Phenytoin, Verapamil
Cardiac arrest is the sudden, abrupt loss of heart function. It is a medical emergency that, unless quickly corrected, is rapidly fatal. Cardiac arrest primarily results from cardiac causes, including electrical dysfunction (heart rhythms) in 80% of people and mechanical failure (pump functions) in 20%. Additional causes may include circulatory shock or abnormalities in ventilation leading to significant cardiopulmonary arrest. Although either the heart or lungs may fail first, both events usually are closely related.
Commonly Prescribed (On-Label) Drugs: Norepinephrine
Off-Label Prescription Drugs Breakthrough Options: Amiodarone, Sodium Bicarbonate, Dobutamine, Magnesium Sulfate, Milrinone
Cardiogenic shock is a disease state where the heart is damaged to the degree that it is unable to supply sufficient blood to the body. The most common cause is an acute heart attack, with left ventricular failure, but it can also be caused by mechanical complications.Cardiogenic shock complicates approximately 6 to 7% of heart attacks.
Commonly Prescribed (On-Label) Drugs: Dopamine
Off-Label Prescription Drugs Breakthrough Options: Milrinone, Nitroprusside
Dilated cardiomyopathy (DCM) is a disease of the heart muscle that causes the heart to become enlarged and to reduce the ability of the heart to pump blood throughout the body. There are many possible causes including infection, injury, and genetics. Frequently the cause is unknown. The deterioration of heart function is usually slow and symptoms are commonly observed when the disease is quite advanced. Fluid can build up in the lungs and this congestion may cause you to experience a feeling of breathlessness.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Captopril, Enalapril, Metoprolol, Propranolol
Hypertrophic cardiomyopathy (HCM) is a rare disorder and affects only one or two people out of 1,000. HCM is a form of cardiomyopathy (disease of the heart muscle) involving thickening of the heart muscle, which interferes with the heart’s function. The thickening is often not symmetrical, affecting one part of the heart more than others and it may interfere with the heart’s functioning by reducing the size of the ventricular chamber. It may also reduce the ability of the valves to work properly. The thickening of the heart muscle may, in some circumstances, obstruct the flow of blood out of the heart.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drugs Breakthrough Options: Verapamil
Chronic cardiac insufficiency is mostly caused by the alteration of the heart's ability to contract. This defect causes an increase in the tension within the heart.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drug Breakthrough Option: Betaxolol
Congestive heart failure (CHF), or heart failure, is a condition defined by a weakened heart that cannot pump enough blood. This can result from: narrowed arteries that supply blood to the heart muscle, coronary artery disease, or heart attack. The scar tissue that may form as a result of this condition can interfere with the heart muscle’s normal work. Other potential causes include high blood pressure and heart valve disease due to past rheumatic fever. Primary disease of the heart muscle itself, called cardiomyopathy, or heart defects present at birth, congenital heart defects, as well as infection of the heart valves and/or heart muscle itself, endocarditis and/or myocarditis, can play a role in congestive heart failure.
Commonly Prescribed (On-Label) Drugs: Amiloride, Bumetanide, Candesartan, Carvedilol, Deslanoside, Digitoxin, Dobutamine, Dopamine, Enalapril, Ethacrynic acid, Fosinopril, Furosemide (Lasix), Hydrochlorothiazide, Inamrinone, Indapamide, Lisinopril, Metolazone, Metoprolol, Milrinone, Nitroprusside, Quinapril, Ramipril, Spironolactone, Torsemide, Trandolapril, Valsartan
Off-Label Prescription Drugs Breakthrough Options: Amiodarone, Atenolol, Bisoprolol, Felodipine, Hydralazine, Isosorbide Dinitrate, Isosorbide Mononitrate, Nitroglycerin IV, Nitroprusside, Prazosin, Spironolactone
Left ventricular dysfunction is a cardiac disorder that impairs, either structurally or functionally, the ability of your left ventricle of the heart to fill with or eject blood. This type of disorder is characterized by shortness of breath, fatigue, and fluid retention. Coronary artery disease is the underlying cause of heart failure in roughly two-thirds of patients with left ventricular dysfunction.
Commonly Prescribed (On-Label) Drugs: None
Off-Label Prescription Drug Breakthrough Option: Nitroglycerin
Acute myocardial infarction (also known as a heart attack) is the death of heart muscle from the sudden blockage of a coronary artery by a blood clot. Coronary arteries are blood vessels that supply the heart muscle with blood and oxygen. Blockage of a coronary artery deprives the heart muscle of blood and oxygen, causing injury to the heart muscle. Injury to the heart muscle causes chest pain and pressure. If blood flow is not restored within 20 to 40 minutes, irreversible death of the heart muscle will begin to occur. Muscle continues to die for six to eight hours, at which time the heart attack usually is "complete." The dead heart muscle is replaced by scar tissue. Approximately one million Americans suffer a heart attack each year. Four hundred thousand of them die as a result of their heart attack.
Commonly Prescribed (On-Label) Drugs: Alteplase, Anistreplase, Aspirin, Clopidogrel, Dalteparin, Enoxaparin, Lisinopril, Ramipril, Reteplase, Streptokinase, Technetium Tenecteplase, Trandolapril, Warfarin
Off-Label Prescription Drugs Breakthrough Options: Dobutamine, Esmolol, Low Molecular Weight Heparin, Lepirudin, Nitroglycerin
The outcome for a person who has had a heart attack depends on the following factors: time to treatment; strength of heart contraction; presence of rhythm disturbances; extent of coronary artery disease and number of coronary arteries involved; presence of congestive heart failure or dangerously low blood pressure; complications such as valve leakage; previous heart attacks, angioplasty, or bypass surgery; and whether the artery causing the heart attack has been successfully dilated so blood can flow through it to the heart muscle.
Commonly Prescribed (On-Label) Drugs: Alteplase, Anistreplase, Aspirin, Dalteparin, Enoxaparin, Lisinopril, Ramipril, Reteplase, Streptokinase, Technetium Tenecteplase, Trandolapril, Warfarin
Off-Label Prescription Drug Breakthrough Option: Acebutolol
Pericarditis is a disorder caused by inflammation of the pericardium, which is the sac-like covering of the heart. The pericardium has an inner and outer layer with a small amount of lubricating fluid between them. When the pericardium becomes inflamed, the amount of fluid between the two layers increases. This squeezes the heart and restricts its action.
Commonly Prescribed (On-Label) Drugs: Penicillin G
Off-Label Prescription Drugs Breakthrough Options: Azathioprine, Colchicine, Indomethacin
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