ARRYTHMIAPRESENTED BY,

Anjali.c

First year m.pharm

Department of pharmacy practice

Grace college of pharmacy

DEFINITION

• Arrhythmias are deviations from normal

heartbeat pattern. They include abnormalities

of impulse formation,such as heart

rate,rhythm,or site of impulse origin and

conduction disturbances,which disrupt the

normal sequence of atrial and ventricular

activation.

NORMAL ELECTRICAL ACTIVITY IN THE

HEART

CLASSIFICATION

1. TACHYARRYTHMIA

a) Atrial:

o Atrial fibrillation

o Atrial flutter

o PSVT

o Automatic atrialTachycardia Atrial

extrasystols

b) Ventricle

oVentricular fibrillation

oVentricular flutter

oVentricular tachycardia

oProarrythmia

oTorsades depoint

oVentricular extrasystole

c) AV node

o AV nodal extra systolic paroxysmal

AV nodal tachycardia

2) BRADY ARRHYTHMIA

o Sick-sinus syndrome(SSS)

o Tachy-brady syndrome

o Heart block

EPIDEMIOLOGY

• It is estimated that 3.9nmillion people in

USA have a cardiac rhythm disturbance

and that is result in 730000 hospital

admissions each year.

• Atrial arrhythmias are more common than

ventricular arrhythmias and atrial fibrillation

(AF) is the commonest chronic arrhythmia.

• Incidence of AF increases with age from

less than 0.1% in the 30-39 year age group

to above 1% in 70-79 year old men.

• Women have a lower risk of AF than male.

ETIOLOGICAL FACTORS

• Heart disease

• Myocardial infarction(MI)

• Systemic hypertension

• Hyperkalemia/hypokalemia

• Chronic obstructive pulmonary disease(COPD)

• Thyroid disorders

• Drug therapy

• Toxic doses of cardioactive drugs

• Increased sympathetic tone

• Vagal stimulation

• Metabolic disturbances

• Cor pulmonale

ETIOPATHOGENESIS

1) Abnormal impulse formation may stem from

• Decreased automaticity, as in escape beats and bradycardia

• Increased automaticity, as in premature beats, tachycardia, and

extrasystole

• Depolarization and triggered activity, leading to sustained

ectopic firing

2)Abnormal impulse conduction results from

• A conduction block or delay

• Reentry occurs when an impulse is rerouted through certain

regions in which it has already travelled. Thus the impulse

depolarizes the same tissue more than once, producing an

additional impulse. Reentry sites include the SA and AV nodes

as well as various accessory conditions must exist:

PATHOPHYSIOLOGY

Inadequate acceleration of sinus rate

MI,HT,Coronaryspasm

Failure of sinus impulseformation

Aortic & mitral valve stenosis

Abrupt sinus prolonged pause

Degeneration or damage of conduction system

SA node dysfunction

AV conduction block

Atrial dysfunction

Ventricular dysfunction

CARDIAC ARRYTHMIA

CLINICAL MANIFESTATION

• Palpitations

• Chest pain

• Anxiety and confusion(reduced blood

perfusion)

• Dyspnea

• Skin pallor or cyanosis

• Abnormal pulse rate, rhythm or amplitude

• Reduced blood pressure

• Syncope

• Weakness

• Convulsions

• Hypotesion

• Decreased urinary output

DIAGNOSIS

ECG strip showing a normal

heartbeat

ECG strip showing bradycardia

ECG strip showing tachycardia

ECG

• Electrophysiological (EP) testing: These intra

cardiac procedures determine the location of

ectopic foci.

• Laboratory findings

• Serum potassium level˃5mEq/L reflects

Hyperkalemia

• serum calcium level˂4.5mEq/L signifies

hypocalcemia

• serum magnesium level˂2.5mEq/L signify

hypomagnesemia

• His bundle study :can locate the origin of a heart

block or reentry pattern

MANAGEMENT

NON-PHARMACOLOGICAL

• Lifestyle changes

• Devices: Implantable cardioverter defibrillator (ICD)

• Cardioversion: This treatment can be chemical or

electric

• Cardiac Ablation: A nonsurgical technique that

neutralizes parts of the abnormal electrical pathway

(tissue) that is causing the arrhythmia

• Cardiac Surgery

Cardiac surgery is an invasive procedure where

surgeons will remove abnormal sites

PHARMACOLOGICAL TREATMENT

CLASS ACTIONS DRUGS

IA Na- channel block Quinidine,procainamide

Disopyramide

IB Na channel block Lidocaine,mexiletine

IC Na –channel block Flecainide,Propafenone

II Beta-blockers Propranolol,esmolol

III K-channel blockers Amidarone,dofetilide

IV Ca-channel blockers Verapramil,diltiazem

V unknown mechanisms Digoxin,adenosine