山东大学药理学研究所.pptVIP

山东大学药理学研究所 丁华 dinghua@sdu.edu.cn CHAPTER 22 ANTIARRHYTHMIC DRUGS 医学院药理学研究所 丁华 Arrhythmia: There is an abnormality in the site of origin of the impulse, its rate or regularity , or its conduction . The type of Arrhythmia: 缓慢型 : 窦性心动过缓 (sinus bradycardia) 房室传导阻滞 (atrio-ventricular block) 快速型 : 房性早搏 (atrial premature contraction) 房性心动过速 (atrial tachycardia,AT) 心房颤动 (atrial fibrillation, AF) 心房扑动 (atrial flutter, AFL) 阵发性室上性心动过速 (paroxysmal supraventricular tachycardia) 室性早搏 (ventricular premature contraction) 室性心动过速 (ventricular tachycardia,VT) 心室颤动 (ventricular fibrillation, VF) ? The Physiological Basis of Arrhythmia 2. The electrophysiological mechanism  of arrhythmias (1) Disturbances in impulse formation: 1) Increased automaticity: 2) Afterdepolarization and triggered: Early afterdepolarization (EAD) Delayed afterdepolarization (DAD) (2) Disturbances in impulse conduction 1) Simple conduction disturbances: conduction ↓,conduction block,unidirectional block. 2) Reentry (circus movement) (3) Both Section 2 The Basic Electrophysilogic Action of Antiarrhythmic Drugs and The Drug Classification 1. The basic electrophysilogic action 2)↓EAD or DAD: ↑repolarization, block Na+ or Ca2+ 3)↓reentry: a.↑conduction: unidirectional block↓ b.↓conduction : unidirectional block→bidirectional block c.↑ERP 2.The classification Vaughan Williams（1971） ClassⅠ Sodium channel-blocking agents: IA , IB, IC ClassⅡ β-blockers Class Ⅲ prolonging repolarization Class Ⅳ calcium antagonists Others: adenosine Section 3 Specific Antiarrhythmic Agents 1. ClassⅠ Sodium channel-blocking agents 1) ClassⅠA a. Inhibit Na+ influx moderately : ↓Vmax, ↓conduction ↓phase 4 slope, ↓automaticity b. ↓ K+ efflux , Increase the E