DISEASE

Arrythmias CVR33
Tachyarrhythmia=HR greater than
conventional number of 100 beats/min
If this occurs for more than 5 consecutive
beats it is
tachycardia=sustained when it lasts for
more than 30 seconds
Paroxysmal tachy: when it starts and stops
abruptly
Incessant tachy: when it occurs most of
the time
**Classic, Ventricular vs Supra-Ventricular
(e.g. by WPW syndrome)
**Electropysiology, wide vs narrow QRS

DRUGS/TRE
ATMENT
Class Ia:
Disopyramid
e, Quinidine,
Procainamide

MECHANISM OF ACTION

NOTE

Ventricular arrhythmias and SVT

Reduce the rate of rise of the action
potential upstroke (phase 0) and prolong
action potential
Kinetics of onset and offset in blocking
the Na+ channel are of intermediate
rapidity (< 5 seconds)
Acts on atrial, ventricular muscle
cells,purkinje fibres and AV node

Class Ib:
Lignocaine,
Mexiletine

Block the Na channels

Treatment for Ventricular arrhythmias
Lignocaine: Administered IV only
Rapidly metabolized /Half life = 30 min
Side effects: High plasma levels cause
drowsiness, paresthesia and seizure
activity
Mexiletine, oral treatment of ventricula
Arrhythmia
Phenytoin, treatment of seizure
disorders.
Used to treat atrial and ventricular
arrhythmias induced by digoxin
Block the fast Na channel (like other
class 1)
No effect on action potential duration
Treatment for both SVT and Ventricular
arrhythmias
Flecanide n propafenone:
Use in life threatening VT and in SVT

SE:
*Quinidine: administered orally, GI side effects.
Cinchonism CNS S/E tinnitus, hearing loss,
visual disturbances, confusion and psychosis.
Antibody induced thrombocytopenia
*Disopyramide: Anticholinergic effects: Nausea,
vomiting, dry mouth, urinary retention
* Procainamide: Given PO, IV or IM. Associated
with N+V, Rash, Arthralgia
-Lupus like syndrome occurs more frequently
and earlier in patients who are slow acetylators of
procainamide
Main SE and given IV is CNS toxicity

Mech of DZ:
Usually associated with structural
abnormality of myocardium
Ischaemia
Heart failure
Hypertrophic Obstructive
Cardiomyopathy
Premature beats: cause of irregular
response
Atrial fibrillation: most common type

Class Ic:
Propafenone,
Flecainide

Flecanide:
SE Proarrythmic, given by
Electrophysiologist
Propafenone:
SE: Exacerbation of lung disease due to partial
beta blocking action

 Given orally
Class II: Beta
blockers
(propranolol,
atenolol )

Class III:
Amiodarone,
Bretylium,
Sotalol

Adrenaline and Noradrenaline act on the

beta receptors in the heart
*Heart 1, lungs and blood vessels 2.
*Have a membrane stabilising effect on
beta receptors
*Act on SA and AV nodes predominantly
*Treat SVT and Ventricular arrhythmias
Act by slowing repolarisation (phase 3),
prolonging the action potential duration.
Amiodarone mainly effects the purkinje
fibres
and ventricular muscle cells.
Rx: Both SVT and Ventricular
arrhythmias
Used in life threatening cases, iv load
followed by oral rx

S.Es: Bronchoconstriction, Heart block, Heart

failure

S.Es: Thyroid disorders, photosensitivity, liver

damage and pulmonary alveolitis
Bretylium:SE: Hypotension main side effect
Sotalol: SE prolong QT interval, beta
blocker SE

Bretylium:used in ICU setting in

patients with recurrent and
refractory ventricular tachyarrythmias

Class IV:
Calcium
Channel
Blockers

Sotalol: Non-specific beta blocker

without prolonging repolarisation
*Exerts negative inotropic effect only
thru -blocking action
*Used to treat ventricular arrhythmias
Verapamil and Diltiazem
Block the L subtype of Ca++ channels
Act on AV node (NB: Ca++ influx only
Treatment of SVT only.

S.Es: CCF, interacts with beta

Blockers

Long QT syndrome
*Inherited arrhythmogenic disease
characterised by life threatening
ventricular arrhythmia
*Autosomal Dominant; Romano-Ward
Recessive assoc with deafness; Jervell
Lange-Nielsen
Brugada Syndrome
Autosomal Dominant Inherited
Structurally normal heart
ST segment elevation in right heart
leads
Susceptible to ventricular tachycardia

Rx with beta blocker, left cardiac

sympathetic denervation or ICD
Implantable Cardiac Defibrillator

Treat with ICD