Pharmacology of antiarrhythmics抗心律失常药理学.pptVIP

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2018-05-06 发布于浙江
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Pharmacology of antiarrhythmics抗心律失常药理学.ppt

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PHARMACOLOGY OF ANTI-ARRHYTHMICS Phase-4 Depolarization results in automaticity of the cardiac action potential, in normal SA nodal cells. Classification of Arrhythmias Bradyarrhythmias Tachyarrhythmias Classification of Antiarrhythmic Drugs (Vaughan-Williams) Class II: β-adrenergic Blockers: Oppose effects of sympathetic tone ? Reduce automaticity (including physiological) ? Slow conduction ? Mainly active in atrial atrioventricular tissue ? Reduce risk of sudden death after heart attack Class II: Examples ? Propranolol ? Metoprolol ? many other -olol’s ? Other aspects of pharmacology: look up autonomic pharmacology notes Non-pacemaker Tissue:Sympathetic activity→Accelerated Conduction Pacemaker:β- adrenoceptor stimulation:→ ↑ automaticity * * Arrhythmia (a-rhythm) means no rhythm,whereas dysrhythmia (dys-rhythm) means an abnormal heart rhythm. In practice,both terms are used interchangeably to mean an abnormal of irregular heart beat. Arrhythmia Cardiac arrhythmias 25% with digitalis 50% Aneathetized patients over 80% with acute myocardial infarction Genesis of Normal Heart Rhythm Genesis of Tachyarrhythmia Antiarrhythmic Drugs Managing Tachyarrhythmias Heart Rhythm Genesis of Normal Heart Rhythm: The Myocardial Action Potential (1) pacemaker activity(2) absence of fast Na+ current in SA and AV nodes, where slow inward Ca2+ current initiates action potentials. (3) long action potential (plateau) and refractory period (4) influx of Ca2+ during the plateau. Electrophysiological Features The Effective Refractory Period(ERP) Genesis of Normal Heart Rhythm : Ion Channel Genesis of Tachyarrhythmia 1 Classification of Arrhythmias 2 Enhanced Automaticity 4 Afterpotentials 3 Reentry Unidirectional Block and Reentry Late After Depolarization Sufficient Preparation Depress resting membrane potential Prolong