沈阳药科大学：《药物化学》课程教学资源（PPT课件讲稿）抗心律失常治疗 Antiarrhythmic Therapy

Antiarrhythmic Therapy 沈阳药科大学药物化学教研室

沈阳药科大学药物化学教研室 Antiarrhythmic Therapy

Antiarrhythmic Therapy Empiric Pathophysiologic Arrhythmia Diagnosis Arrhythmia Diagnosis Known or suspected mechanisms BLACK BOX Critical components Vulnerable parameters Targeted subcellular units Interventions Interventions Clinical Outcomes Clinical Outcomes

Antiarrhythmic Therapy Empiric Arrhythmia Diagnosis Interventions Clinical Outcomes Interventions Clinical Outcomes Pathophysiologic Arrhythmia Diagnosis Known or suspected mechanisms Critical components Vulnerable parameters Targeted subcellular units BLACK BOX

Antiarrhythmic Therapy Pathophysiologic AV node reentrant tachycardia Arrhythmia Diagnosis Known or suspected AV node reentry mechanisms Anatomical fast/slow Critical components pathway Vulnerable parameters Targeted subcellular units L-type Cat channel Interventions Catt channel blocker B-blocker Clinical Outcomes Sinus rhythm

Antiarrhythmic Therapy Pathophysiologic Arrhythmia Diagnosis Interventions Clinical Outcomes Known or suspected mechanisms Critical components Vulnerable parameters Targeted subcellular units AV node reentrant tachycardia AV node reentry Anatomical fast/slow pathway AV node (slow conduction) AV nodal action potential L-type Ca++ channel Ca++ channel blocker -blocker Sinus rhythm

Vaughn-Williams Classification Based on cellular properties of normal His-Purkinje cells Classified on drug's ability to block specific ionic currents i.e. Nat, K+, Catt) and beta-adrenergic receptors Advantages: Physiologically based Highlights beneficial/deleterious effects of specific drugs

Vaughn-Williams Classification • Based on cellular properties of normal His-Purkinje cells • Classified on drug’s ability to block specific ionic currents (i.e. Na+ , K+ , Ca++) and beta-adrenergic receptors • Advantages: – Physiologically based – Highlights beneficial/deleterious effects of specific drugs

Antiarrhythmic Therapy Empiric Goals Arrhythmia Diagnosis .Identify the type of dysrhythmia . Be familiar with more common BLACK BOX antiarrhythmics and their Vaughn-Williams Classification Interventions Clinical Outcomes

Antiarrhythmic Therapy Empiric Arrhythmia Diagnosis Interventions Clinical Outcomes BLACK BOX Goals •Identify the type of dysrhythmia •Be familiar with more common antiarrhythmics and their Vaughn-Williams Classification

Arrhythmia Types Slow Fast Fast wide Fast narrow oo fast

Arrhythmia Types • Slow • Fast Fast wide Fast narrow Too fast

Arrhythmia-focused Therapy Fast Narrow Supraventricular tachycardias Re-entry type OrthodromiC SVT Automatic AET Atrial Flutter JET

Arrhythmia-focused Therapy • Fast Narrow • Supraventricular tachycardias – Re-entry type • Orthodromic SVT – Automatic • A.E.T. , Atrial Flutter • J.E.T

Arrhythmia-focused Therapy Fast wide (rare) Antidromic SVT or SVT with abberancy Ventricular tachycardia Inappropriate automaticity of ventricular or His-Purkinje tissue

Arrhythmia-focused Therapy • Fast Wide – (rare) Antidromic SVT or SVT with abberancy – Ventricular tachycardia • Inappropriate automaticity of ventricular or His-Purkinje tissue

Arrhythmia-focused Therapy Select one antiarrhythmic or a limited group of antiarrhythmics to treat the disorder

Arrhythmia-focused Therapy • Select one antiarrhythmic or a limited group of antiarrhythmics to treat the disorder

Antiarrhythmic Agents Vaughn-Williams Classification Class -Nat-channel blockers(direct membrane action) Class -Sympatholytic agents ClassⅢ· Prolong repolarization Class v- Cat+- channel blockers Purinergic agonists Digitalis glycosides

Antiarrhythmic Agents Vaughn-Williams Classification • Class I - Na+ - channel blockers (direct membrane action) • Class II - Sympatholytic agents • Class III - Prolong repolarization • Class IV- Ca++ - channel blockers • Purinergic agonists • Digitalis glycosides