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Introduction
Cardiac cells: Contractile muscle cells (CMC) and
Special conducting tissue.
Normal cardiac rhythm
Impulse generation: S.A node at a rate of 60-100per min.
Impulse propagation: SAN AVN His-Purkinje CMC
AV nodal delay = 0.15sec
Arrhythmia: Any different from the Normal rhythm.
Abnormal: - Origination, rate/ regularity, conduction.
Arrhythmias can be: Bradyarrhythmia or tachyarrhythmia.
Three important points to note
Automaticity
The ability of a cell to alter its resting membrane
potential toward the excitation threshold without the
influence of an external stimulus
Conduction velocity
Refractory period
Depolarized cardiac cells are transiently unresponsive
to any activation stimuli. During this interval, most Na+
and some Ca++ channels are inactivated, and the
cardiac myocytes are said to be refractory.
Phases of cardiac AP
Phase 0: Fast inward Na+ current
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Triggered Automaticity (contd)
DAD may occur in the presence of a rapid heart rate,
digitalis glycosides, hypokalemia, hypercalcemia &
catecholamines which leads to an increase in intracellular
ca2+ that activates an inward ionic current.
The arrhythmia may respond to L-type calcium channel
antagonists or inhibitors of -adrenoceptor.
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Reentry
Abnormality of impulse conduction.
Cause for 80 to 90% of clinical arrhythmias
Class IC: No/little effect on APD & Dissociate with slow kinetics
Flecainide, Propafenon
Class II: Block -adrenergic Receptors.
Propranolol, Acebutolol, Metoprolol
Class IC
Produce marked depression in the rate of rise
of the membrane action potential (markedly
delay conduction)
Minimal effect on the duration of membrane
action potential.
Application:
In reentrant tachycardia (most types of atrial
arrhythmias & also used for life-threatening
ventricular arrhythmias in absence of structural heart
disease)
Class II: -AR Blockers
The primary action of drugs in this class is to
suppress adrenergically (sympathetic) mediated
ectopic activity
-Stimulation:
Increase Ca++ current & slow its inactivation.
Reduce automaticity
Verapamil, Diltiazem
Effect: slows HR occasionally increased HR
supraventricular tachycardia
PSVT Adenosine Esmolol Digoxin Propafenone
Diltiazem Verapamil
Verapamil Propranolol