治疗心律失常的药物.pptVIP

Anti-arrhythmic drugs Dr Isla Mackenzie Clinical Lecturer Clinical Pharmacology Seminar Content Physiology of normal cardiac rhythm Definition and mechanisms of arrhythmias Classification of drugs to treat arrhythmias Important anti-arrhythmic drugs (mechanism and pharmacological characteristics) Arrhythmias in clinical practice  Physiology of cardiac rate and rhythm Cardiac myocytes are electrically excitable Resting intracellular voltage of myocardial cells is negative -90mV (SA node is -40mV) Resting state - K+ inside and Na+ outside cell (Na+/K+ pump) Action potential occurs when Na+ enters the cell and sets up a depolarising current Stimulation of a single muscle fibre causes electrical activity to spread across the myocardium Phases of action potential of cardiac cells Phase 0 rapid depolarisation (inflow of Na+) Phase 1 partial repolarisation (inward Na+ current deactivated, outflow of K+) Phase 2 plateau (slow inward calcium current) Phase 3 repolarisation (calcium current inactivates, K+ outflow) Phase 4 pacemaker potential (Slow Na+ inflow, slowing of K+ outflow) ‘autorhythmicity’ Refractory period (phases 1-3) Sinus rhythm Sinoatrial node is cardiac pacemaker Normal sinus rhythm 60-100 beats/min Depolarisation triggers depolarisation of atrial myocardium (‘forest fire’) Conducts more slowly through AV node Conducts rapidly through His bundles and Purkinje fibres Sinus rhythm Sinoatrial rate controlled by autonomic nervous system Parasympathetic system predominates (M2 muscarinic receptors) Sympathetic system (?1 receptors) Increased heart rate (positive chronotropic effect) Increased automaticity Facilitation of conduction of AV node ECG Recording of electrical activity of the heart Net sum of depolarisation and repolarisation potentials of all myocardial cells P-QRS-T pattern P - atrial depolarisation QRS - ventricular depolarisation T - ventricular repolarisation Definition of arrhythmia Cardiac arrhythmia is an abnormality of the heart rhythm Bra