In addition to the three main classes of anti-hypertensives we already discussed, ACE Inhibitors like Lisinopril and Captopril, Beta Blockers like Metoprolol and Propranolol, and Calcium Channel Blockers like Nicardipine and Diltiazem, there are a number of other classes of medications we can anticipate when caring for a cardiac patient.
These include Anticoagulants like Heparin, Warfarin, Eliquis, and Xarelto, or Antiplatelet agents like Aspirin and Plavix. These are used to decrease and prevent clotting and may be seen in patients with atrial fibrillation, cardiac stents, or artificial heart valves.
You may also see ARBs like Losartan and Valsartan as well as Combined Alpha and Beta Blockers like carvedilol to supplement the functions we’ve already seen with Beta Blockers and ACE inhibitors. You may also see Digitalis agents like Digoxin to improve the efficiency of the heart and Vasodilators which help to decrease preload (which you’ll learn about on another card).
There are also some common lab values that are important to monitor with cardiac patients. First and foremost is Potassium. The normal potassium level is 3.5 to 5 and any deviation from that most commonly presents with EKG changes and dysrhythmias like V-Fib or V-Tach.
Low potassium causes a U wave (a dip after the T wave) or ST depression (it goes down) and can also increase the risk of digoxin toxicity. High potassium causes Peaked T waves and a Widened QRS (high = bigger and taller). It’s also important to monitor magnesium because it has a direct effect on the contractility of the heart muscle and can cause heart blocks or even V-Tach.
The BNP or B-Natriuretic Peptide is indicative of how severely the heart muscle is being stretched. The higher it is, the worse the heart failure and volume overload. We also monitor H&H for volume status and possible anemia, as well as a Lipid and cholesterol panel due to the risks associated with atherosclerosis.