Arrythmias and anti-arrythmic drugs Flashcards
What is another term for arrythmias?
Dysrhythmia
What does arrythmia mean?
Disturbances in cardiac rhythm
What are the different types of arrythmias?
Bradycardia
Atrial flutter
Atrial fibrillation
Tachycardia
Ventricular fibrillation
What are the types of tachycardia? How are they different?
Ventricular tachycardia - arises from ventricles
Supraventricular tachycardia - arises from above ventricles
What care the causes of ventricular tachycardia?
Ectopic pacemaker activity
Afterdepolarisations
What causes ectopic pacemaker activity?
Damaged area of myocardium
Depolarised because sodium ions leak into cell
Generates action potentials
Dominates over SA node
What is an afterpolarisation?
Abnormal depolarisations following the action potential
What are the causes of supraventricular tachycardias?
Atrial flutter
Atrial fibrillation
Re-entry loop
- atria
- AV node
What are the causes of bradycardia?
Sinus bradycardia
Conduction block
What is sinus bradycardia?
Heart beat still in sinus rhythm
Just below 60bpm
What are the causes of sinus bradycardia?
Intrinsic factors - SA node dysfunction
Extrinsic factors - drugs e.g. beta blockers, some Ca2+ channel blockers
What is sick sinus syndrome?
Cardiac arryhtmias caused by intrinsic SA node dysfunction
What are the causes of conduction block?
Intrinsic factors - problems with AV node, bundle of His
Extrinsic factors - drugs e.g. beta blockers, some Ca2+ ion blockers
What are delayed after-depolarisations?
Membrane depolarises before next action potential
When are delayed after-depolarisations more likely?
When intracellular Ca2+ conc. is high
What are early after depolarisations?
Membrane depolarises during plateu phase of action potential
or during repolarisation phase
What can early after-depolarisations lead to?
Oscillations in the membrane potential
When are early after-depolarisations more likely?
Longer action potential
so a longer QT interval
What happens when two impulses meet each other normally? Why?
Impulses cancel out
due to adjacent area being in refractory period
What is a unidirectional block?
Impulse cannot be conducted in a certain direction along an area of myocardium
How can a re-entry loop occur?
Unidrectional block prevents impulse conduction in a certain direction
Action potential travels via longer route
Goes the opposite way through the uridirectional block
What causes atrial fibrillation?
Multiple re-entry loops in atria
What causes the formation of multiple re-entry loops in the atria?
Stretching of atrial muscle
conductive tissue becomes damaged, irritated
What is AV nodal re-entry?
Formation of re-entry loop within the AV node
What is meant by ventricular pre-excitation?
Ventricles become depolarised before they normally should do
What causes ventricular pre-excitation?
Accessory conductive pathway between atria and ventricles
What else can the accessary conductive pathway cause?
Re-entry loops between atria and ventricles
How does tachycardia affect output?
Reduces time in diastole
reduces filling time of heart, EDV
reduces SV, CO
What are the different types of anti-arrythmic drugs?
1) Block VG Na+ channels
2) B-adrenoceptor antagonists
3) Block K+ channels
4) Block Ca2+ channels
What is an example of a drug that blocks VG Na+ channels?
Lidocaine
What mechanism does lidocaine use to block VG Na+ channels?
Use-dependent
blocks VG Na+ channels that are open or inactivated
How does lidocaine affect the normal upstroke of the action potential?
It doesn’t
What can lidocaine be used to treat? Why?
Ventricular tachycardia
prevents action potentials being generated in damaged depolarised tissue
How does lidocaine affect the next action potential?
It doesn’t
dissociates in time for next action potential
How is lidocaine given?
IV route
What are some examples of B-adrenoceptor antagonists?
Propanolol
Atenolol
Where do B-adrenoceptor antagonists work in the heart
At B1 adrenoceptors
What are the effects of B-adrenoceptor antagonists?
Decrease slope of pacemaker potential in SA node
Slow down conduction at AV node
When are B-adrenoceptors more effective?
Increased sympathetic input to heart
What are B-adrenoceptor antagonists useful to treat?
Supraventricular tachycardia
Following MI
Why are B-adrenoceptor antagonists useful to treat supraventricular tachycardias?
Because they slow down conduction in AV node
Which slows down rate of ventricular depolarisation and contraction
Why are B-adrenoceptor antagonists useful to treat MIs?
Block increased sympathetic drive, possible arrythmias
Reduce oxygen demand, ischaemia
by reducing heart rate, force of contraction
How do drugs that block K+ cannels affect the action potential?
Delay repolarisation
Delay the refractory period
Delay the action potential
Why are drugs that block K+ channels generally not used?
Because they can be pro-arrythmic
How can drugs that block K+ channel be pro-arrythmic?
Longer repolarisation
prone to early-after depolarisations
Which drug that blocks K+ channels is used frequently?
Amiodarone
What are some other effects of amiodarone?
Blocks Ca2+ channels
Beta blocker
What is amiodarone used to treat?
Tachycardia by Wolff-Parkinson-White syndrome
Ventricular arrythmias by MI
What is an example of a drug that blocks Ca2+ channels in the heart?
Verapimil
What are the effects of verapimil?
Decreases upstroke of action potential in SA node
Decreases conduction of AV node
Negative inotropy - decreases force of contraction
Dihydropyridine Ca2+ channel blockers are not effective to treat…?
Arrythmias
Dihydropyridine Ca2+ channel blockers act on…?
Vascular smooth muscle
What is an example of a dihydropyridine Ca2+ channel blocker?
Nicarpidine
What is another group of Ca2+ channel blockers?
Dihydropyridine Ca2+ channel blockers
Where are adenosine receptors located in the heart?
AV node
What are the adenosine receptors?
A1 receptors
What type of receptor are A1 receptors?
GPCRs
What are the effects of adenosine binding to A1 receptors?
Release of active beta-gamma subunit
What does the active beta-gamma subunit do?
Increases conductivity of K+ channels
hyperpolarising the cells of the AV node
What is adenosine useful to treat?
Re-entrant superventricular tachycardias
How is adenosine given?
IV
Is adenosine produced endogenously or not?
Yes it is