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Cardiac Arrhythmia
Cardiac Arrhythmia
DAD
Torsades de pointes: polymorphic ventricular tachycardia along
with prolonged QT interval
DAD: precipitating conditions are intracellular or sarcoplasmic
Ca2+ overload, adrenergic stress, digitalis intoxication, heart
failure
If afterdepolarizations reach a threshold, an AP is genererated
which is called ‘triggered beat’
DAD occur when the HR is fast, EAD occur when the HR is
slow
•Re-entry: when a cardiac impulse travels in a path such as to
return to and reactivate its original site and self perpetuate rapid
reactivation independent of normal sinus node conduction
Requirements for re-entry rhythm:
slowing or conduction failure due to either an anatomic or
functional barrier
Anatomic barrier- Wolff-Parkinson-White syndrome
Functional barrier- ischaemia, differences in refractoriness
Presence of an anatomically defined circuit
Heterogenecity in refractoriness among regions in the circuit
Slow conduction in one part of the circuit
•What are channels? – they are macromolecular complexes
consisting of a pore forming subunit, subunits and accessory
proteins
•They are:
Transmembrane proteins
Consist of a voltage sensitive domain
A selectivity filter
A conducting pore and,
An inactivating particle
•In response to changes in membrane voltage, the channel changes
conformation so as to allow or prevent the flow of ions through it
along their concentration gradient
K+ (Transient)
K+ (delayed rectifier)
Ca2+ Ca2+
Na+ Na+
Na+K+ATPase
K+
K+ channel blocker
-blocker, CCB