This document summarizes a lecture on pharmacotherapy of arrhythmia and heart failure given by Dr. T.S. Mohamed Saleem. The lecture defines different types of arrhythmias including atrial fibrillation, atrial flutter, ventricular tachycardia, and bradyarrhythmias. It discusses their clinical presentations, diagnosis, management including drug treatment and ablation, and evaluation of treatment outcomes. It also defines heart failure and discusses its pathophysiology, clinical presentation, diagnosis, treatment including use of diuretics, ACE inhibitors and beta blockers, and evaluation of treatment response.

1. PHARMACOTHERAPY
OF ARRHYTHMIA
LECTURE BY
DR. T.S. MOHAMED SALEEM M.PHARM., PH.D
17-03-2015
Dr. T.S. Mohamed Saleem
1

2. DEFINITION
• Loss of cardiac rhythm
• Abnormality in the rate, regularity and sequence
• Supraventricular tachycardias
• Atrial fibrillation (AF) or atrial flutter,
• Paroxysmal supraventricular tachycardia (PSVT)
• Automatic atrial tachycardias.
17-03-2015
Dr. T.S. Mohamed Saleem
2

3. ATRIAL FIBRILLATION
AND ATRIAL FLUTTER
• Atrial Fibrillation
• Extremely rapid and disorganized atrial activation.
• Heart beat - 400 to 600 atrial beats/min
• Pulse - 120 to 180 beats/min
• Atrial Flutter
• Rapid but regular atrial activation
• Heart beat - 270 to 330 atrial beats/min
• Pulse - 300 beats/min
• Reentry of organic heart disease
17-03-2015
Dr. T.S. Mohamed Saleem
3

4. VENTRICULAR TACHYCARDIA
• Three or more repetitive premature ventricular complexes
(PVCs) occurring at a rate greater than 100 beats/min.
• Causes
• Myocardial infarction
• Electrolyte abnormalities
17-03-2015
Dr. T.S. Mohamed Saleem
4

5. BRADYARRHYTHMIAS
• Heart rate less than 60 beats/min
• Sinus node dysfunction
• AV block or conduction delay
17-03-2015
Dr. T.S. Mohamed Saleem
5

6. CLINICAL
PRESENTATION
• Minor palpitations
• Irregular beats
• Dizziness
• Anginal pain
• Syncope
• Hypotension
• Hemodynamic collapse
• Cardiac arrest
17-03-2015
Dr. T.S. Mohamed Saleem
6

7. DIAGNOSIS
• ECG
• Direct asculation
• upright body-tilt test
17-03-2015
Dr. T.S. Mohamed Saleem
7

8. DESIRED OUTCOME
• Restoring sinus rhythm
• Preventing thromboembolic complications
• Preventing further recurrences.
17-03-2015
Dr. T.S. Mohamed Saleem
8

9. MANAGMENT
• GENERAL APPROACH
• Ablation
• Implantable cardioverter-defibrillator (ICD).
• Drug Treatment
• Classification system is that proposed by Vaughan
Williams
17-03-2015
Dr. T.S. Mohamed Saleem
9

10. 17-03-2015
Dr. T.S. Mohamed Saleem
10

11. TREATMENT
ALGORITHM
17-03-2015
Dr. T.S. Mohamed Saleem
11

12. 17-03-2015
Dr. T.S. Mohamed Saleem
12
TEE- Transesophagal echocardiogram

13. 17-03-2015
Dr. T.S. Mohamed Saleem
13

14. EVALUATION OF
THERAPEUTIC OUTCOMES
• Mortality
• Arrhythmia reoccurrence
• Hemodynamic consequences
• Treatment complications
17-03-2015
Dr. T.S. Mohamed Saleem
14

15. PHARMACOTHERAPY
OF HEART FAILURE
17-03-2015
Dr. T.S. Mohamed Saleem
15

16. DEFINITION
• Inability of heart to pump the blood
• Diastolic dysfunction
• Systolic dysfunction
17-03-2015
Dr. T.S. Mohamed Saleem
16

17. PATHOPHYSIOLOGY
SYSTOLIC
DYSFUNCTION
• Myocardial
infarction
• Dilated
cardiomyopathy
• Ventricular
hypertrophy
• Pressure
overload
• Volume
overload
DIASTOLIC
DYSFUNCTION
• Ventricular stiffness
• Ventricular hypertrophy
• Ischemia and infarction
• Valve stenosis
• Pericardial disease
17-03-2015
Dr. T.S. Mohamed Saleem
17

18. CLINICAL
PRESENTATION
• Asymptomatic to cardiogenic shock
• Dyspnoea
• Fatigue
• Exercise intolerance
• Pulmonary congestion
• Peripheral edema
17-03-2015
Dr. T.S. Mohamed Saleem
18

19. DIAGNOSIS
• Complete blood count
• Serum electrolytes
• Renal, hepatic and thyroid function
• Chest x-ray
• Echocardiogram - LVEF
17-03-2015
Dr. T.S. Mohamed Saleem
19

20. DESIRED OUTCOME
• Improved QOL
• Relieve or reduce symptoms
• Low morbidity
• Slow disease progression
• Prolong survival
17-03-2015
Dr. T.S. Mohamed Saleem
20

21. 17-03-2015
Dr. T.S. Mohamed Saleem
21

22. TREATMENT
• Determine aetiology or precipitating factor
• Treatment of underlying disorders
• Cardiac rehabilitation
• Fluid restriction Max 2 L/day
• Dietary sodium (2-3 g /day)
• Smoking cessation and control of hypertension, diabetes mellitus,
and dyslipidemia
• Patient with multiple vascular risk factor – ACE inhibitors and ARBs
• To reduce further injury – ACE inhibitors and Beta blockers
• Structural heart disease – diuretics, aldosterone antagonist, digoxin
and vasodilators
• Symptoms at rest - Mechanical circulatory support, continuous
intravenous positive inotropic therapy, cardiac transplantation
17-03-2015
Dr. T.S. Mohamed Saleem
22

23. TREATMENT
ALGORITHM
17-03-2015
Dr. T.S. Mohamed Saleem
23

24. 17-03-2015
Dr. T.S. Mohamed Saleem
24

25. 17-03-2015
Dr. T.S. Mohamed Saleem
25

26. EVALUATION OF
THERAPEUTIC OUTCOMES
• Patient interaction
• Regular bodyweight monitoring
• Pulmonary congestion monitoring
• Blood pressure monitoring
• Serum electrolytes and renal function monitoring
• Beta blockers monitoring
17-03-2015
Dr. T.S. Mohamed Saleem
26