updated latest,dr anjani kr jha,resident int medicine,nomc,nepal

1. ANTIARRHYTHMIC
AGENTS
DR.ANJANI KUMAR JHA
RESIDENT/INTERNAL MEDICINE
NOBEL MEDICAL COLLEGE
2020/05/31

2. OUTLINE OF PRESENTATION
• NORMAL CONDUCTION SYSTEM OF
HEART
• ACTION POTENTIAL
• ARRYTHMIAS
• CLASSIFICATION OF ANTIARRHYTHMIC
AGENTS
• DESCRIPTIONS
• PRINCIPLES OF USE
• OTHER TREATMENT MODALITIES
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3. PHYSIOLOGY OF CARDIAC
MUSCLE
• 3 major types of cardiac muscle (atrial,
ventricular and specialized excitatory and
conductive muscle fibers).
• Cardiac muscle is syncytium(a network of
cardio-myocytes connected by intercalated
discs).
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4. NTIARRHYTHMIC 4
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5. EXCITATION CONTRACTION
COUPLING
• This term refers to the mechanism by which
the action potential causes the myofibrils of
the muscles to contract.
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7. ACTION POTENTIAL
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24. Cardiac arrhythmias
• The causes of the cardiac arrhythmias are usually one
or a combination of the following abnormalities in the
rhythmicity-conduction system of heart
I. Abnormal rhythmicity of pacemaker
II. Shift of the pacemaker from SA to another place in the
heart.
III. Blocks at different points in the spread of impulses through
the heart.
IV. Abnormal pathways of impulse transmission through the
heart.
V. Spontaneous generation of spurious impulses in almost any
part of the heart.
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25. • Ventricular arrhythmias originate from a focus of
myocardial or purkinje cells capable of
automaticity, or triggered automaticity, or from
reentry through areas of scar or a diseased
purkinje system.
• They are characterized by their ECG appearance
and duration.
• Conduction away from the ventricular focus
through the ventricular myocardium is slower
than activation of the ventricles over the purkinje
system.
• Hence, the QRS complex during ventricular
arrhythmias will be wide, typically more than
0.12 sec.
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28. Ventricular arrhythmias
• PVCs
• VT
• MONOMORPHIC VT
• VENTRICULAR FLUTTER
• POLYMORPHIC VT
• TORSADE DE POINTES
• VENTRICULAR FIBRILLATION
• IDIOPATHIC VENTRICULAR RHYTHM
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35. Treatment options:
• Antiarrhythmic drugs
• Implantable cardioverter defibrillators
• Catheter ablation for VT
• Arrhythmia surgery
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65. References
• Harrison’s principles of internal medicine 20th
edition
• Davidson’s principles and practice of medicine
23rd edition
• Uptodate 2020
• Lippincott pharmacology 6th edition
• Guyton and hall textbook of medical physiology
13th edition
• first aid for the USMLE step 1, 2018
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