Medicine an Surgery notes

Apr 24th, 2015
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CARDIAC ARRYHTHMIASNot all ECG documented arrhythmias require treatment.The physician must consider the balance between the symptomatic and prognostic significance of the arrhythmia and the potential side effects of the therapy.Arrhythmias may arise either from abnormal automaticity triggered after depolarization or from disorders of impulse conduction e.g. re-entry phenomenon.Examples of re-entry phenomenon include;Atrial flutter and fibrillationSupraventricular tachycardiaVentricular tachycardiaVentricular fibrillationTrigger activity is the likely basis for the arrhythmias of digitalis toxicity.Classification of anti-arrhythmic drugs;(Vaughan Williams Classification)ClassDrugsI. Fast sodium channel inhibitorsIa; Quinidine, procainamide, disopyramideIb; Lidocaine, phenytoin, mexiletine, tocainideIc; FlecainideII. Antisympathetic agentsBeta-blockersIII. Prolongation of action potential durationAmiodarone, bretylium, sotalolIV. Slow calcium channel antagonistsVerapamil, diltiazemNot ClassifiedDigoxin, adenosineClass I action;Agents with class I activity block sodium channels and reduce the rapid inward sodium current.This results in slowing of conduction, an increase in refractory period, or bothThe action is sometimes referred to as local anaesthetic or membrane stabilizing.Class I agents are subdivided further according to their subsidiary properties;Class Ia agents lengthen action potential duration moderately and cause minor slow

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