Cardiac Arrhythmias

y Physiology
y Normal Sinus rhythm y Abnormal rhythm y Disturbance of impulse formation y Disturbance of impulse conduction

y Arrhythmias
y Tachycardia, bradycardia y Atrial flutter, fibrillation y PVC, premature ventricular contraction

Therapeutic Agents
y Rational y Aim of therapy y MOA y Na+ channel block y SANS block on heart y Prolong refractory period y Ca+ block

Class I
y Quinidine
y Synchronism

Class III
y Bretylium (Bretylol) y Sotolol (Betapace)

y Procainamide y Amiodarone y Lidocaine

yClass II
y Beta-blockers y propranolol

yClass IV
y

Ca+ Channel Blockers

y y

Verapamil (Calan) Diltiazem (Cardizem)

Clinical Therapy
y Evaluation y Risk versus Benefit y Non-Drug Therapy

yCASE STUDY

y DP is a slender, 45-year-old mother of three

children all under the age of 15 years old. She presents to clinic with palpitations, sweating and hyperventilation. EKG reveals she is experiencing PVC s every 10-12 beats. She is agitated and appears to be worried that her husband will be angry with her for getting sick.
y BP 140/85 P 110 Temp 38.6 Wt 55 kg Ht 5 7 y Currently on no medications

Points to Ponder
y Evaluate this patient s condition and possible

etiologies. y Discuss the risks versus benefits of anti-arrhythmic therapy. Goals of therapy? y Is DP a candidate for drug treatment of her PVC s? y Consider avenues of non-drug therapy.