70 y/o male , chest pain short of breath

[EMS49393]

It's a darn good thing I keep my PDR close by me. Let me clean up what I stated about diltiazem.

Contraindications: hypotension, cardiogenic shock, second or third degree AV block, sick sinus syndrome except in presence of a functioning ventricular pacemaker. Acute MI, pulmonary congestion. IV diltiazem with IV beta blockers. Atrial fibrillation of atrial flutter associated with an accessory pathway bypass tract (WPW, PR syndrome). Ventricular tachycardia. Use of lyoJect in newborns. Lactation.

Special considerations: CHF. Hepatic disease. Effects of coadministration of diltiazem and beta blocks is unpredictable. Safety and effectiveness in children has not been determined. Half-life may be increased in geratic patients.

If you consider pulmonary congestion and pulmonary edema to be two entirely separate things in the field, than I retract my statement of contraindication and offer it to be a part of special considerations. Pulmonary edema was listed as a contraindication with the protocols for my last service. Personally, I wouldn't administer diltiazem to any patient that presents with pulmonary congestion and/or edema in the field. My xray machine on my ambulance has been down for some time, and instead of debating what is causing the pulmonary edema, I'd opt to use the alternative which would be amiodarone.

As I have said before, I weigh risks of interventions with benefits. Although I'm an aggressive assessor, I am cautious with any interventions. There is no such thing as a "benign" intervention on my ambulance.

[Mateo_1387]

Thanks for the reply, that answers my question.

I am picking your brain a little bit here. Why would you want to use amiodarone instead of the cardizem for a-fib with pulmonary edema? This question is for anyone really.

[EMS49393]

I'm going to attempt to answer your question. The vessels relax because calcium channel blockers slow the rate that calcium flows through the vessel walls. I would assume that because blood flow is increased in the vessels, so is the chance of further back up of fluid in the lungs and/or extremities. Calcium channel blockers are listed with cautions for patients that have vessel diseases and congestive heart failure. I believe the mechanism of action for these drugs increases the demand on the already ailing vasculature.

I'm not entirely sure I'm answering your question correctly. I thought about it for several hours before I felt I had an acceptable answer. I'd be really interested to have one of our site Physicians offer up their explanation. I'm interested to know if any of my education actually paid off.