Antiarrhythmic agent resident survival guide: Difference between revisions
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==Do's== | ==Do's== | ||
* Toxic levels of quinidine cause severe QRS widening and ventricular arrhythmias. (may reverse with the infusion of sodium lactate or sodium bicarbonate). | |||
==Don'ts== | ==Don'ts== | ||
Revision as of 17:22, 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 | Predominantly sodium channel blocker with some potassium channel blocking activity | *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 | Quinidine, procainamide, disopyramide | 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 | Slows conduction, & prolongs repolarization | 2-20 mcg/min | 0.03 unit/min | 20-300 mcg/kg/min | 2.5-20 mcg/kg/min | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Indications | Pre-excited atrial arrhythmias PSVT, Ventricular tachycardia | Arrhythmia (more β1) | *Coronary spasm *Splanchnic vasoconstriction | Reflex bradycardia (only α1) | Hypotension (β2) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Complications | abdominal cramping, diarrhea, rash cinchonism (hearing decrease, tinnitus, and blurred vision, thrombocytopenia, hemolytic anemia, lupus syndrome , granulomatous hepatitis, QRS widening and ventricular arrhythmias (may reverse with sodium lactate or sodium bicarbonate). | *Not in cardiogenic shock *Arrhythmia *Ischemia induced cardiotoxicity | *Ischemic heart *Gut ischemia | *Bradycardia *Heart block | *Hypotension (add α1 agonist) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Toxic levels of quinidine cause severe QRS widening and ventricular arrhythmias. (may reverse with the infusion of sodium lactate or sodium bicarbonate).
Don'ts
- Do not start with low dose Dopamine dose to perfuse the kidney.