临床药理arrhyth资料.ppt

治疗心律失常药物Antiarrhythmic agents 一、Basic Concept 正常心率（窦性心律）：The electrical impulse that triggers a normal cardiac contraction originates at regular intervals in the sinoatrial node , usually at a frequency of 60-100 beats per minute. This impulse spreads rapidly through the atria and enters the atrioventricular node, then propagates over the His-Purkinje system and invades all parts of the ventricles. 心律失常： Arrhythmias consist of cardiac depolarizations that deviate from the above description in one or more aspects—ie, there is an abnormality in the site of origin of the impulse, its rate or regularity, or its conduction 。 心律失常分类 总的可分快速型和过缓型 （然后根据发生部位和性质再分） 快速型：房早，房速，房颤； 室早，室速，室颤 过缓型（缓慢型）：房室传导阻滞，束支传导阻滞，窦性心动过缓等，阿托品，拟肾上腺素药物等有一定作用。 心律失常的治疗学分类 就临床治疗的观点，心律失常可分为三类： 良性（无器质性病变）benign arrhythmias: VPBs, sinus tachycardia using Anxiolytics and Sedatives 可能恶性（轻中度器质性病变）potential malignant arrhythmias： Paroxysmal Supraventricular Tachycardia, monomorphic ventricular tachycardia, atrial fibrillation 恶性（重度器质性病变）malignant arrhythmias (life-threatening arrhythmias)：sustained ventricular tachycardia, polymorphic ventricular tachycardia, ventricular fibrillation 二、Pathophysiology Arrhythmias develop because of abnormal impulse generation, abnormal propagation or both Bradyarrhythmias Which arise through abnormalities of intrinsic automatic behavior or conduction, principally within the atrioventricular node and the His-Purkinjes network. Tachyarrhythmias Three mechanisms have been associated with many tachyarrhythmias Altered automaticity: Factors that increase automaticity include mechanical stretch beta-adrenergic stimulation hypokalemia Triggered automaticity: Early Afterdepolarization (EAD)早后除极 which is associated with significant prolongation of the action potential duration. Factors that predispose to EAD: bradycardia low extracellular K+ certain drugs, including some antiarrhythmics Torsades de pointes, a polymorphic ventricular arrhythmia- associated with Prolonga