Antiarrhythmic agent resident survival guide: Difference between revisions
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{{Family tree | | | | | B01 | | B02 | | B03 | | B04 | | B05 | | B06 | |B01='''[[Class IA]]''' |B02='''[[Class IB]]''' |B03='''[[Class IC]]''' |B04='''[[Class II]]'''|B05='''[[Class III]]''' |B06='''[[Class IV]]''' }} | {{Family tree | | | | | B01 | | B02 | | B03 | | B04 | | B05 | | B06 | |B01='''[[Class IA]]''' |B02='''[[Class IB]]''' |B03='''[[Class IC]]''' |B04='''[[Class II]]'''|B05='''[[Class III]]''' |B06='''[[Class IV]]''' |B07= }} | ||
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{{Family tree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | |C01= '''Mechanism''' |C02= *Mainly predominant'''α1''' agonist (Vasoconstrictive) <br> *some β1 agonist (↑contractility) |C03= *Mainly predominant '''β1''' agonist (↑ cardiac contractility) <br> * some α1 agonist(Vasoconstrictive)|C04= *'''V<sub></sub>1''' receptor of GIT vasculatures <br> *Antidiuretic effects |C05= *'''Pure α1''' agonist(Vasoconstrictive) <br> *No β1 |C06= *Predominant '''β1''' agonist (↑contractility) <br> *β2 arterial smooth muscle (Hypotensive) }} | {{Family tree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | |C01= '''Mechanism''' |C02= *Mainly predominant'''α1''' agonist (Vasoconstrictive) <br> *some β1 agonist (↑contractility) |C03= *Mainly predominant '''β1''' agonist (↑ cardiac contractility) <br> * some α1 agonist(Vasoconstrictive)|C04= *'''V<sub></sub>1''' receptor of GIT vasculatures <br> *Antidiuretic effects |C05= *'''Pure α1''' agonist(Vasoconstrictive) <br> *No β1 |C06= *Predominant '''β1''' agonist (↑contractility) <br> *β2 arterial smooth muscle (Hypotensive) |C07= }} | ||
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{{Family tree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | |D01= '''Agents''' |D02= *'''1st''' line in : <br> *'''Septic shock''' <br> *'''Cardiogenic shock''' <br>*Undifferentiated shock |D03= 2nd line septic shock |D04= 2nd line septic shock |D05= '''1st''' line '''Neurogenic shock''' <BR> 3rd-4th line septic shock |D06= *1st line '''cardiogenic shock''' <BR>* low output septic shock }} | {{Family tree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | |D01= '''Agents''' |D02= *'''1st''' line in : <br> *'''Septic shock''' <br> *'''Cardiogenic shock''' <br>*Undifferentiated shock |D03= 2nd line septic shock |D04= 2nd line septic shock |D05= '''1st''' line '''Neurogenic shock''' <BR> 3rd-4th line septic shock |D06= *1st line '''cardiogenic shock''' <BR>* low output septic shock |D07= }} | ||
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{{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | |E01= '''Effect''' |E02= 1-30 mcg/min <br>0.01-0.3mcg/kg/min |E03= 2-20 mcg/min |E04= 0.03 unit/min |E05= 20-300 mcg/kg/min |E06= 2.5-20 mcg/kg/min }} | {{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | |E01= '''Effect''' |E02= 1-30 mcg/min <br>0.01-0.3mcg/kg/min |E03= 2-20 mcg/min |E04= 0.03 unit/min |E05= 20-300 mcg/kg/min |E06= 2.5-20 mcg/kg/min |E07=}} | ||
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{{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | | F07| |F01= '''Indications''' |F02= Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) |F03= Arrhythmia (more β1) |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br>(only α1) |F06= Hypotension (β2) }} | {{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | | F07| |F01= '''Indications''' |F02= Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) |F03= Arrhythmia (more β1) |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br>(only α1) |F06= Hypotension (β2) |F07=}} | ||
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | ||
{{Family tree | G01 | | G02 | | G03 | | G04 | | G05 | | G06 | |G01= '''Complications''' |G02= Arrhythmia |G03= *'''Not in cardiogenic shock''' <br>*Arrhythmia <br> *Ischemia induced cardiotoxicity|G04= *Ischemic heart <br> *Gut ischemia |G05= *Bradycardia <br> *Heart block |G06= *Hypotension (add α1 agonist) }} | {{Family tree | G01 | | G02 | | G03 | | G04 | | G05 | | G06 | | G07 | |G01= '''Complications''' |G02= Arrhythmia |G03= *'''Not in cardiogenic shock''' <br>*Arrhythmia <br> *Ischemia induced cardiotoxicity|G04= *Ischemic heart <br> *Gut ischemia |G05= *Bradycardia <br> *Heart block |G06= *Hypotension (add α1 agonist) |G07=}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
Revision as of 16:55, 12 December 2013
Template:Antiarrhythmic agent Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Definition
Causes
Life Threatening Causes
Common Causes
Prognosis
Vaughan-Williams classification of antiarrhythmic agents
| Vaughan-Williams classification of antiarrhythmic agents | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Class IA | Class IB | Class IC | Class II | Class III | Class IV | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Mechanism | *Mainly predominantα1 agonist (Vasoconstrictive) *some β1 agonist (↑contractility) | *Mainly predominant β1 agonist (↑ cardiac contractility) * some α1 agonist(Vasoconstrictive) | *V1 receptor of GIT vasculatures *Antidiuretic effects | *Pure α1 agonist(Vasoconstrictive) *No β1 | *Predominant β1 agonist (↑contractility) *β2 arterial smooth muscle (Hypotensive) | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Agents | *1st line in : *Septic shock *Cardiogenic shock *Undifferentiated shock | 2nd line septic shock | 2nd line septic shock | 1st line Neurogenic shock 3rd-4th line septic shock | *1st line cardiogenic shock * low output septic shock | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Effect | 1-30 mcg/min 0.01-0.3mcg/kg/min | 2-20 mcg/min | 0.03 unit/min | 20-300 mcg/kg/min | 2.5-20 mcg/kg/min | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Indications | Tachyarrhythmia {less β1 effect} ( less than Dopamine ) | Arrhythmia (more β1) | *Coronary spasm *Splanchnic vasoconstriction | Reflex bradycardia (only α1) | Hypotension (β2) | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Complications | Arrhythmia | *Not in cardiogenic shock *Arrhythmia *Ischemia induced cardiotoxicity | *Ischemic heart *Gut ischemia | *Bradycardia *Heart block | *Hypotension (add α1 agonist) | ||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Assess the cause of shock
- Always volume fluid resuscitation first
- Norepinephrine in undifferentiated shock.
- Titrate dobutamine according to clinical response slowly ( 2-20 ug/kg/min ) to avoid tachycardia (10% increase from the baseline). The benefit that dobutamine has as minimal effect on myocardial oxygen demand is lost if it is not well titrated.
Don'ts
- Do not start with low dose Dopamine dose to perfuse the kidney.