Herbal antiarrhythmic drugs for the heart. The most effective antiarrhythmic drugs
ANTI-ARITHMIC MEDICINES
Used for violations of the rhythm of heart contractions - arrhythmias. The causes of arrhythmias are pathological changes in the myocardium.
Types of arrhythmias (determined by ECG data).
1. Depending on the location of the pathological focus:
a) supraventricular (supraventricular);
b) ventricular.
2. By the nature of rhythm disturbance:
a) tachyarrhythmias (extrosystole, paroxysmal tachycardia, flutter, atrial fibrillation and ventricular fibrillation);
b) bradyarrhythmias (various blockades and weakness of the sinus node).
Mechanisms of arrhythmias
1. Violation of the formation of impulses, that is, the occurrence of pathological foci of excitation.
2. Violation of the conduction of impulses as a result of the block.
MECHANISM OF EXCITATION AND CONTRACTION IN THE MYOCARDIA
Under the influence of the action potential of the cells of the sinus node, the permeability of the cell membranes changes. Ca** and Na* enter inside the cell, K* comes out. The contractile mechanism is activated, contraction occurs, then Ca** ions are removed from the cell, relaxation occurs.
Excitation (action potential)
Maple membrane
Inlet Ca** and Na* Outlet K*
cell contraction
Exit Ca**
Cell relaxation
The main causes of rhythm disturbances are electrolyte disturbances, that is, a deficiency of K * and Mg **, an excess of Na * and Ca ** that occur in the myocardium under the influence of hypoxia, inflammatory processes, toxic or autoimmune damage, increased tone of SS innervation, excess thyroid hormones glands.
P\arrhythmic drugs belong to different chemical and pharmacological groups. Only quinidine, novocainamide, ethmozine and aymaline are used only as antiarrhythmics.
CLASSIFICATION OF ANTI-ARITHMIC DRUGS
I. For the treatment of tachyarrhythmias.
1) Membrane stabilizing drugs (sodium channel blockers). Divided into 3 gr.
2) b-adrenolytics (b-blockers).
3) Drugs that slow down repolarization (potassium channel blockers).
4) Antagonists of Ca ions ** (calcium channel blockers).
5) Drugs of other groups (cardiac glycosides, potassium preparations, magnesium preparations, hawthorn n-ka, adenosine).
II. For the treatment of bradyarrhythmias.
M-cholinolytics (in / in 0.1% solution of atropine).
B-agonists (izadrin sublingually or intravenously, orciprenaline (alupent) inside).
The mechanism of action of all a / arrhythmic cf-in is based on the effect on cell membranes and the transport of Na *, K *, Ca **, Cl * ions through them. As a result, electrophysiological processes in the myocardium change.
ANTI-ARRHYTHMIC DRUGS FOR THE TREATMENT OF TACHYARHYTHMIAS
Membrane-stabilizing drugs - disrupt the transport of Na* and K* ions through the membranes of the heart fibers. The properties of the fibers change, the excitability, conductivity and automatism of the fibers of the conduction system of the heart decrease. Subdivided into 3 groups:
1gr.- Meh-m: block the entry of Na* ions through the fast sodium channels of the cell membrane.
Application: extrasystoles, ventricular tachyarrhythmias, supraventricular (paroxysmal tachycardia, atrial fibrillation).
Side effects: the appearance of signs of heart failure, a decrease in blood pressure, in large doses - AV block, mx / blocking effect (dry mouth, blurred vision); when ingested, nausea, vomiting.
Quinidine is an alkaloid from cinchona bark. Dextrorotatory isomer of quinine.
Side effects: ototoxic, hemolysis, hepatitis. It is impossible for arrhythmias associated with intoxication with cardiac glycosides.
PV tab 0.1 and 0.2.
extended forms:
Quinidine-durules
Kinileptin
Procainamide (Novocainamide) - similar in structure and properties to novocaine (has a local anesthetic effect), according to indications and f-log effects - with quinidine (less M-anticholinergic effect), in addition, convulsions, psychosis, a condition similar to systemic red lupus. It is impossible for arrhythmias associated with intoxication with cardiac glycosides.
PV tab 0.25; 10% solution, 5 ml.
Aymalin (Rauwolfia snake alkaloid) - parenterally.
Pulsnorma (aymalin + phenobarbital) - antiarrhythmic and hypotensive, dragee.
Disopyramide (ritmilen, ritmodan, norpeys) has a negative inotropic effect and a peripheral anticholinergic effect.
2 gr.-Meh-m: promote the release of K* ions from myocardial cells, accelerate the process of repolarization of cell membranes, shorten the action potential and refractory period. Suppress the automatism of ectopic foci of excitation in the ventricles. Do not adversely affect conductivity.
Lidocaine (Xycaine) and Trimecaine are local anesthetics.
Application: drugs of choice for ventricular arrhythmias, myocardial infarction.
Side effects: dizziness, convulsions, nausea, vomiting, lowering blood pressure. Enter in / m and / in.
Mexiletine (Ritalmex) and tocainide, an analog of lidocaine with a longer duration of action, are effective when taken orally.
VW capsules and solutions for intravenous administration.
Phenytoin (difenin) is an antiepileptic drug. Similar to lidocaine in antiarrhythmic properties. It is effective only for arrhythmias caused by intoxication with cardiac glycosides and heart operations. PV tablets.
3 gr.- Meh-m: (cm 1 gr) - block the entrance of Na *, but less than 1 gr inhibit the conductivity and contractility of the myocardium.
Ethmozine (moriciazine) and etacizine are well absorbed from the gastrointestinal tract. Assign inside and parenterally.
Application: ventricular arrhythmias.
Side effects: nausea, dizziness, blurred vision, own arrhythmogenic effect. VW tab and 2.5% solutions for injections.
Beta-adrenolytics (see the lecture "Beta-adrenolytics")
Propranolol (anaprilin, obzidan) is a non-selective beta-blocker that blocks the effect of adrenergic innervation on the heart, as well as circulating adrenaline. At the same time, the activity of the sinus node and ectopic foci is suppressed. Reduces automatism, excitability and conduction of the myocardium. Stabilizes the content of potassium ions in the heart muscle. Effective in supraventricular and ventricular tachyarrhythmias, including those associated with cardiac glycosides.
Side effect: associated with the blockade of beta2-adrenergic receptors of other organs (bronchospasm, cold extremities due to deterioration of peripheral circulation).
Atenolol (tenolol) is a beta1-adrenolytic (cardioselective). It does not cause side effects on beta2-adrenergic receptors, it is better tolerated. It is used for the same indications as propranolol.
Atenolol analogues: metoprolol, talinolol, bisoprolol, betaxolol, acebutolol, nebivolol, etc.
Drugs that slow down repolarization
Amiodarone (cordarone) is a highly effective antiarrhythmic drug. Mech-m action: increases the duration of the action potential, due to the blockade of potassium channels. Slows down the conduction of the impulse through the conduction system, but does not affect the contractility of the myocardium. Expands coronary vessels. Application: supraventricular and ventricular arrhythmias. Side effect: deposition of pigment in the cornea of the eye, headache, changes in the lungs, dysfunction of the thyroid gland (TC contains iodide ion).
Contraindications: violation of atrioventricular conduction, bradycardia, pregnancy, lactation. PV tab 0.2
Sotalol (Sotalex, Sotohexal) is a non-selective beta-blocker. Reduces blood pressure - even normal. Lasts about 25 hours. But doctors recommend taking 2 times a day.
Application: arrhythmias, angina pectoris. FV
Bretylium (ornid) is a sympatholytic, most effective in ventricular arrhythmias. VW 5% solution for intravenous and intramuscular administration.
Calcium channel blockers (Ca ion antagonists**)
Meh-m action and f-log effects: block calcium channels in cell membranes, mainly in the smooth muscles of blood vessels and the heart. Antiarrhythmic action is associated with a decrease in excitability, conductivity and automatism of the fibers of the sinus and atrioventricular nodes. They have a negative inotropic effect (weaken, lengthen systole). As a result, they reduce blood pressure, have an antiplatelet effect and reduce blood viscosity. They have antianginal action.
Verapamil (lekoptin, isoptin, veronorm) and diltiazem (cardil) are the drugs of choice for supraventricular tachyarrhythmias.
Side effect:
in high doses, they reduce myocardial contractility, causing AV block;
constipation, headache, fatigue, swelling in the legs.
Drugs of other groups
cardiac glycosides. With arrhythmias, only digitalis preparations are prescribed in tablets:
Purple: cordigite, digitoxin;
Woolly: Digoxin, Medilazide, Celanide
Potassium preparations cause an increase in the rhythm of heart contractions. Reduce excitability, conductivity and contractility of the myocardium. In small doses, they dilate the coronary vessels of the heart, in large doses, they cause a spasm of the coronary vessels.
Well absorbed from the gastrointestinal tract, excreted through the kidneys.
In case of an overdose, the phenomenon of paresthesia is observed: itching on the skin, burning, "crawling crawling" is accompanied by a tick on the face. Kidney function is impaired. Cardiac arrest, as a result of spasm of the coronary vessels. Application: hypokalemia when taking soluretics, digitalis intoxication, arrhythmias.
Potassium chloride - after eating, because it strongly irritates the gastrointestinal mucosa. PV tab 0.5
Potassium - normin, calinor, kalipoz - tab in the shell, before meals, without chewing.
Magnesium preparations reduce the heart rate, the excitability of ventricular cardiomycetes.
Magnesium sulfate 20% solution is used to stop ventricular arrhythmias, poisoning with cardiac glycosides.
Magnesium chloride, magnesium orotate (magnerot), magnesium aspartate and magnesium gluconate are used to prevent and treat hypomagnesemia.
Magne B6, magnesium-plus, magnil - combined preparations of magnesium.
Combined preparations of potassium and magnesium. Application: cardiac arrhythmias caused by hypokalemia and hypomagnesemia.
Asparkam and panangin are analogues, contain potassium and magnesium asparaginates. The action develops gradually. Asparkam acts more sharply and less long. FV tab, dragee, solution for injections.
Polarizing mixture - composition: 5% glucose solution -500 ml; 6 units of insulin; 1.5 potassium chloride; 2.5 magnesium sulfate. In/in drip.
Hawthorn tincture - hawthorn preparations increase the contraction of the heart muscle and at the same time reduce its excitability. Increase blood circulation in the coronary vessels of the heart and in the vessels of the brain. Analogues: novocainamide, quinidine, ethmozine.
Drugs for the treatment of bradyarrhythmias, bradycardias and conduction disorders (see classification).
Content
In medicine, antiarrhythmic drugs are used to normalize the rhythm of heart contractions. Such drugs are intended only to control the clinical symptoms of diseases in which the functioning of the heart muscle is impaired. Antiarrhythmics have no effect on life expectancy. Depending on the nature of the heart rhythm changes, antiarrhythmic drugs from different pharmacological groups and classes are prescribed. Their reception should be long and under the strict control of electrocardiography.
Indications for the use of antiarrhythmic drugs
The muscle cells of the heart, called cardiomyocytes, are permeated with a large number of ion channels. Arrhythmia is directly related to their work. It develops as follows:
- Through cardiomyocytes, the movement of sodium, potassium and chlorine ions occurs.
- Due to the movement of these particles, an action potential is formed - an electrical signal.
- In a healthy state, cardiomyocytes contract in synchrony, so the heart works normally.
- With arrhythmia, this well-established mechanism fails, which leads to a violation of the propagation of nerve impulses.
To restore the normal contraction of the heart, antiarrhythmic drugs are used. Medications help reduce the activity of the ectopic pacemaker. Literally, ectopia means the occurrence of something in the wrong place. With an ectopic rhythm, electrical excitation of the heart occurs in any part of the conductive fibers of the myocardium, but not in the sinus node, which is an arrhythmia.
Drugs against arrhythmia act by blocking certain ion channels, which helps to stop the circulation of the pathological impulse. The main indications for the use of such drugs are tachyarrhythmias and bradyarrhythmias. Certain drugs are prescribed taking into account the clinical symptoms of the pathology and the presence or absence of structural pathologies of the heart. Arrhythmias, in which antiarrhythmics are prescribed, are associated with the following diseases:
- ischemic heart disease (CHD);
- disorders of the central nervous system (CNS);
- stress;
- hormonal disorders during pregnancy, menopause;
- inflammatory diseases of the heart (rheumatic heart disease, myocarditis);
- electrolyte imbalances in hypercalcemia and hypokalemia;
- hyperfunction of the thyroid gland and other endocrine pathologies;
- cardiopsychoneurosis.
Classification of antiarrhythmic drugs
The criterion for classifying antiarrhythmics is their main effect on the production of electrical impulses in cardiomyocytes. Different antirhythmics show a certain effectiveness only in relation to specific types of arrhythmias. Taking into account this factor, the following groups of antiarrhythmic drugs are distinguished:
- Class 1 antiarrhythmics are membrane-stabilizing sodium channel blockers. They directly affect the functional abilities of the myocardium.
- Class 2 antiarrhythmics are beta-blockers. They act by reducing the excitability of the heart muscle.
- Class 3 antiarrhythmics are potassium channel blockers. These are new generation antiarrhythmic drugs. Slow down the flow of potassium ions, thereby lengthening the time of excitation of cardiomyocytes. This helps to stabilize the electrical activity of the heart.
- Class 4 antiarrhythmics are calcium antagonists, or blockers of slow calcium channels. They contribute to the lengthening of the time of insensitivity of the heart to a pathological impulse. As a result, abnormal contraction is eliminated.
- Other antiarrhythmic drugs. These include tranquilizers, antidepressants, cardiac glycosides, sedatives, neurotropic drugs. They have a complex effect on the myocardium and its innervation.
- Herbal preparations with antiarrhythmic action. These drugs have a milder effect and fewer side effects.
Membrane stabilizing sodium channel blockers
These are class 1 antiarrhythmic drugs. Their main action is to stop the flow of sodium ions into cardiomyocytes. As a result, the wave of excitation passing through the myocardium slows down. This eliminates the conditions for the rapid circulation of ectopic signals in the heart. The result - the arrhythmia stops. Sodium channel blockers are further divided into 3 subclasses depending on the effect on the time of repolarization (return of the potential difference that occurred during depolarization to the initial level):
- 1A - lengthen the time of repolarization;
- 1B - shorten the time of repolarization;
- 1C - do not affect the time of repolarization.
1A class
These antiarrhythmic drugs are used for extrasystole - ventricular and supraventricular. Atrial fibrillation is also an indication for their use. This is a violation of the heart rhythm, in which the atria contract frequently and chaotically, and fibrillation of individual groups of atrial muscle fibers is observed. The main effect of class 1A drugs is the inhibition of rapid depolarization (prolongation of repolarization) of the action potential in the myocardium. Due to this, the normal sinus rhythm of the heart contractions is restored. Examples of such drugs:
- Quinidine. Lowers the tone of veins and arteries, blocks the penetration of sodium ions into myocardial cells, exhibits antipyretic and analgesic effects. Indications: atrial fibrillation, paroxysmal supraventricular tachycardia, frequent extrasystoles. Quinidine should be taken half an hour before meals. The standard dosage is 200-300 mg up to 4 times a day. contraindications: cardiac decompensation, pregnancy, idiosyncrasy. Side effects include nausea, vomiting, diarrhea, allergies, and cardiac depression.
- Novocainamide. Reduces the excitability of the heart, suppresses ectopic foci of excitation, exhibits a local anesthetic effect. It is indicated for extrasystoles, paroxysms of atrial fibrillation, paroxysmal tachycardia. The initial dose is 1 tablet 1 hour before or 2 hours after a meal. Then the dose is increased to 2-3 pieces per day. Maintenance dosage - 1 tablet every 6 hours. Novocainamide is prohibited in violation of the conduction of the heart and severe heart failure. Of its side effects, general weakness, insomnia, nausea, headache, and a sharp drop in blood pressure are noted.
1B class
These antiarrhythmic drugs are ineffective in atrial fibrillation because they have little effect on the sinus node, the degree of conduction and myocardial contractility. In addition, such drugs shorten the repolarization time. For this reason, they are not used for supraventricular arrhythmia either. Indications for their use:
- extrasystole;
- paroxysmal tachycardia;
- arrhythmias provoked by an overdose of cardiac glycosides.
A class 1B antiarrhythmic is represented by the local anesthetic Lidocaine. Its active component increases the permeability of membranes for potassium ions and at the same time blocks sodium channels. Lidocaine affects the contractility of the heart in significant dosages. Indications for use:
- ventricular arrhythmias;
- relief and prevention of recurrent ventricular fibrillation in patients with acute coronary syndrome;
- repeated paroxysms of ventricular tachycardia, including in the postinfarction and early postoperative period.
To stop an arrhythmic attack, 200 mg of Lidocaine is administered intramuscularly. If there is no therapeutic effect, then the procedure is repeated after 3 hours. In severe arrhythmia, jet intravenous administration and subsequent intramuscular injection are indicated. Lidocaine contraindications:
- sinoatrial blockade;
- severe bradycardia;
- cardiogenic shock;
- Adam-Stokes syndrome;
- pregnancy;
- lactation;
- sick sinus syndrome;
- heart failure;
- violations of intraventricular conduction.
Intravenous and intramuscular injections of Lidocaine are used with caution in chronic heart failure, sinus bradycardia, arterial hypotension, hepatic and renal dysfunction. Side effects of the drug:
- euphoria;
- dizziness;
- headache;
- disorientation;
- disturbances of consciousness;
- vomiting, nausea;
- collapse;
- bradycardia;
- pressure drop.
1C class
The arrhythmogenic effect of antiarrhythmic drugs of this group has led to the restriction of their use. Their main effect is the lengthening of intracardiac conduction. A representative of such antiarrhythmics is the drug Ritmonorm based on propafenone. This active ingredient slows down the flow of blood sodium ions into cardiomyocytes, thereby reducing their excitability. Indications for Ritmonorm's use:
- severe ventricular paroxysmal tachyarrhythmia, which is a threat to life;
- supraventricular paroxysmal tachyarrhythmias;
- AV nodal and supraventricular tachycardia in patients with paroxysmal atrial fibrillation.
Ritmonorm tablets are taken orally, swallowed whole, so as not to feel their bitter taste. Adults weighing over 70 kg are prescribed 150 mg up to 3 times a day. After 3-4 days, the dosage can be increased to 300 mg 2 times. If the patient's weight is less than 70 kg, treatment is started with a lower dose. It is not increased if therapy lasts less than 3-4 days. Among the common side effects of Ritmonorm are nausea, vomiting, metallic taste in the mouth, dizziness, headache. Contraindications to the use of this drug:
- myocardial infarction in the last 3 months;
- Brugada syndrome;
- changes in water and electrolyte balance;
- age up to 18 years;
- myasthenia gravis;
- obstructive chronic pulmonary disease;
- co-administration with ritonavir;
- pronounced changes in the myocardium.
Beta blockers
Class 2 antiarrhythmics are called beta-blockers. Their main actions are lowering blood pressure and dilating blood vessels. For this reason, they are often used in hypertension, myocardial infarction, circulatory failure. In addition to lowering pressure, beta-blockers contribute to the normalization of the pulse, even if the patient has resistance to cardiac glycosides.
The drugs of this group are effective in increasing the tone of the sympathetic nervous system against the background of stress, vegetative disorders, hypertension, ischemia. Due to these pathologies, the level of catecholamines in the blood increases, including adrenaline, which acts on myocardial beta-adrenergic receptors. Beta-blockers interfere with this process by preventing overstimulation of the heart. The described properties are:
- Anaprilin. Based on propranolol, which is an adrenergic blocker of indiscriminate action. Reduces heart rate, reduces myocardial contractility. Indications: sinus, atrial and supraventricular tachycardia, arterial hypertension, exertional angina, prevention of migraine attacks. Start taking 40 mg 2 times a day. The daily dose should not exceed 320 mg. For heart rhythm disturbances, it is recommended to take 20 mg 3 times a day with a gradual increase to 120 mg, divided into 2-3 doses. Contraindications: arterial hypotension, sinus bradycardia, sinotrial blockade, heart failure, bronchial asthma, metabolic acidosis, tendencies to bronchospasm, vasomotor rhinitis. Of the adverse reactions, the development of muscle weakness, Raynaud's syndrome, heart failure, vomiting, and abdominal pain is possible.
- Metoprolol. It is a cardioselective adrenoblocker with antianginal, hypotensive and antiarrhythmic effects. The drug is indicated for hypertension, myocardial infarction, supraventricular, ventricular, and atrial fibrillation, sinus and atrial tachycardia, atrial flutter and fibrillation, ventricular premature beats. Daily dosage - 50 mg 1-2 times. The side effects of metoprolol are numerous, so they should be clarified in the detailed instructions for the drug. The drug is contraindicated in cardiogenic shock, acute heart failure, lactation, intravenous infusion of Verapamil, arterial hypotension.
Potassium channel blockers
These are class 3 antiarrhythmic drugs. They slow down electrical processes in cardiomyocytes by blocking the penetration of potassium ions into these cells. In this category of antiarrhythmics, amiodarone is more commonly used. It is based on the component of the same name, which exhibits coronary vasodilatory, antiarrhythmic and antianginal effects. The latter is due to the blockade of b-adrenergic receptors. Additionally, amiodarone reduces heart rate and blood pressure. Indications for use:
- flicker paroxysm;
- prevention of ventricular fibrillation;
- ventricular tachycardia;
- atrial flutter;
- parasystole;
- ventricular and atrial extrasystoles;
- arrhythmias against the background of coronary and chronic heart failure;
- ventricular arrhythmias.
The initial dose of Amiodarone is 600-800 mg per day, which is divided into several doses. The total dosage should be 10 g, it is reached in 5-8 days. After taking, dizziness, headaches, auditory hallucinations, pulmonary fibrosis, pleurisy, vision problems, sleep and memory disturbances may be observed. Amiodrone is contraindicated in:
- cardiogenic shock;
- collapse;
- hypokalemia;
- sinus bradycardia;
- insufficient secretion of thyroid hormones;
- thyrotoxicosis;
- taking MAO inhibitors;
- weak sinus node syndrome;
- under the age of 18.
calcium antagonists
Class 4 antiarrhythmics are slow calcium channel blockers. Their action is to block the slow current of calcium, which helps to suppress ectopic foci in the atria and reduce the automatism of the sinus node. These drugs are often used for hypertension because they can lower blood pressure. Examples of such drugs:
- Verapamil. It has antianginal, hypotensive and antiarrhythmic actions. Indications: atrial fibrillation, sinus, supraventricular tachycardia, supraventricular extrasystole, stable exertional angina, hypertension. Prohibited Verapamil during pregnancy, lactation, severe bradycardia, arterial hypotension. The dosage is 40-80 mg per day. After administration, facial flushing, bradycardia, nausea, constipation, dizziness, headache, weight gain may occur.
- Diltiazem. It works in the same way as Verapamil. Additionally improves coronary and cerebral blood flow. Diltiazem is used after a myocardial infarction, with hypertension, diabetic retinopathy, exertional angina, supraventricular tachycardia, attacks of atrial fibrillation. The dosage is selected individually depending on indications. Diltiazem contraindications: atrioventricular block, severe hypertension, atrial fibrillation and flutter, renal failure, lactation. Possible side effects: paresthesia, depression, dizziness, fatigue, bradycardia, constipation, nausea, dry mouth.
Other drugs for arrhythmias
There are drugs that are not related to antiarrhythmic, but have this effect. They help with paroxysmal tachycardia, mild attacks of atrial fibrillation, ventricular and supraventricular extrasystoles. Examples of such drugs:
- Cardiac glycosides: Korglikon, Strofantin, Digoxin. They are used to restore sinus rhythm, stop supraventricular tachycardia.
- Preparations containing magnesium and potassium ions: Panangin, Asparkam. Help to reduce the speed of electrical processes in the myocardium. Indicated for ventricular and supraventricular arrhythmias.
- Cholinolytics: Atropine, Metacin. These are antiarrhythmic drugs for bradycardia.
- Magnesium sulfate. It is used for arrhythmia of the "pirouette" type, which occurs after a liquid protein meal, long-term use of certain antiarrhythmics and severe electrolyte disturbances.
Antiarrhythmic agents of plant origin
Herbal preparations, including antiarrhythmic ones, are safer. In addition to normalizing the heart rate, most of them exhibit sedative, analgesic and antispasmodic effects. Examples of such drugs:
- Valerian. Contains an extract of the plant of the same name. It has a sedative, antiarrhythmic, choleretic and analgesic effect. Take 1 per day – 2 tablets or 20-40 drops 3 times. Contraindications: first trimester of pregnancy, deficiency of lactase, sucrase or isomaltase, age up to 3 years, glucose-galactose absorption. Side effects include drowsiness, constipation, lethargy, and muscle weakness. Price - 50 tablets - 56 rubles.
- Motherwort. Based on an extract of the plant of the same name. Shows hypotensive and sedative effects. The dosage is 14 mg 3-4 times a day. Contraindication - high sensitivity to the composition of the drug. Adverse reactions: rash, irritation and redness on the skin. The price of tablets is 17 rubles.
- Novo-passit. Contains extracts of hops, lemon balm, St. John's wort, hawthorn and guaifenesin. Has a sedative effect. The drug is taken 1 tablet 3 times a day. Adverse reactions: dizziness, vomiting, constipation, spasms, nausea, increased drowsiness. Prohibited remedy for myasthenia gravis, under the age of 12 years. Price - 660 rubles. for 60 tablets.
- Persen. Contains extracts of lemon balm, peppermint, valerian. Shows soothing, sedative and antispasmodic properties. Take the medicine 2-3 times a day, 2-3 tablets. After taking, the development of constipation, skin rash, bronchospasm, hyperemia is possible. Contraindications Persen: arterial hypotension, fructose intolerance, pregnancy, lactation, age less than 12 years, cholelithiasis.
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An arrhythmia is a violation, failure of the heart rate. The rhythm of myocardial work can be disturbed due to:
- changes in the regulation of the activity of the heart;
- excitability disorders;
- automatism and conductivity due to intoxication;
- ischemia;
- electrolyte disorders.
To normalize the heart rhythm, antiarrhythmic drugs are prescribed, they are very diverse in terms of pharmacological groups and classes. These chemical compounds are designed to eliminate the manifestations of arrhythmia and prevent their occurrence. With their help, you can not increase life expectancy, but you can control the manifestations of clinical symptoms, using them, you can quite successfully.
Antiarrhythmics are serious drugs prescribed by a cardiologist when diagnosing a patient with a pathological arrhythmia that interferes with a full life and threatens with complications. These funds have a positive effect on the human body, because the regulated heart rhythm ensures normal blood circulation, timely delivery of oxygen to cells, tissues, internal organs, which ensures the proper functioning of all systems. The intake of these drugs is strictly controlled, their effects are monitored by means of an electrocardiogram at least once every twenty days, the course of treatment is long.
Treatment of arrhythmia is aimed at restoring sinus rhythm.
The patient is admitted to the hospital of the cardiology department and takes antiarrhythmic drugs orally, or they are administered intravenously. When the desired effect is not observed from the measures taken, electrical cardioversion is indicated. If there are no chronic cardiac pathologies, the restoration of sinus rhythm can be carried out at home with periodic visits to the doctor. In rare attacks of arrhythmia, when symptoms are short and infrequent, medical supervision becomes dynamic.
Mechanism of influence
To stabilize the heart rate, patients are shown antiarrhythmic drugs that affect the electrophysiology of the myocardium and contribute to:
- Decreased excitability of the heart muscle.
- Slowing down the sharpness of the potential, leading to a decrease in excitation.
- Reducing the sensitivity of the heart to electrical discharge and the risk of ventricular fibrillation.
- An increase in the period of effective refractoriness, a reduction in tachycardia manifestations, as well as the elimination of impulses following immediately after the optimal contraction with little or no interruption.
- Reducing the duration of relative refractoriness and shortening the interval when a contractile impulse is possible.
- A rapid reduction in the likelihood of the "re-entry" phenomenon, as homogenization occurs due to the rapidly increasing rate of the conducted excitation.
- An increase in the duration of diastolic depolarization, which depresses the focus of ectopic automatism.
- An equal time interval during which refractoriness and excitation occur.
Classification
The classification of antiarrhythmic drugs is considered in four main classes, distinguished depending on the ability of a particular drug to conduct electrical signals. There are several types of arrhythmia, in accordance with which a specific type of drug is selected, which differs in its effect. The following are popular antiarrhythmic drugs, the classification of which is expressed according to the main methods and areas of influence:
- Membrane-stabilizing sodium channel blockers that affect the performance of the heart muscle: Quinidine, Flecainide, Lidocaine.
- Beta-blockers are able to coordinate the innervation of the myocardium, reduce the risk of death due to coronary insufficiency, and prevent the recurrence of tachyarrhythmia. This group includes: "Bisoprolol", "Propranolol", "Metoprolol".
- Potassium channel blockers: Ibutilide, Sotalol, Amiodarone.
- Calcium antagonists: Diltiazem, Verapamil.
There are also other medications, which include tranquilizers, cardiac glycosides, neurotropics and sedatives. They have a combined effect on the innervation and functioning of the myocardium.
Features of the main antiarrhythmics
| Class | Medicine name | Impact | Mode of application |
| 1A | Quinidine (cinchona bark) |
| Inside during meals, without chewing |
| 1B | "Lidocaine" |
| 200 mg of the drug is administered intramuscularly. If there is no positive dynamics, after 3 hours the injection is duplicated. Particularly severe cases require intravenous administration |
| 1C | Propafenone, Ritomnorm |
| |
| 2 | "Propranolol" - a beta-blocker |
| Due to the gradual accumulation in the tissues of elderly patients, doses are reduced over time |
| 3 |
| Since the drug is toxic, the dose is prescribed individually, and it is necessary to constantly monitor the pressure and other criteria. | |
| 4 | "Verapamil" |
| After accumulation, it is excreted by the kidneys. Release form: tablets, injections, dragees. The number of contraindications is minimal, well tolerated in most cases |
Other medicines that stabilize the heart rate
The above classification of antiarrhythmic drugs does not include some drugs that also have a similar effect on the heart muscle. Among them:
- Cardiac glycosides: control the heart rate. Bright representatives of the group are Strofantin, Digoxin.
- Cholinolytics: accelerate the heart rate in bradycardia. This includes Atropine.
- Magnesium sulfate eliminates the phenomenon called "pirouette". This is a special ventricular tachycardia that occurs subsequently due to electrolyte failures. It is also provoked by a liquid protein diet and prolonged exposure to certain antiarrhythmics.
Herbal remedies for arrhythmia
Among the remedies of natural origin are medicines used in modern traditional medicine to normalize the heart rhythm.
- Motherwort. Basis for alcohol tincture. The optimal dosage of the drug is 30 drops, taken three times a day. To prepare motherwort infusion at home, you need to take a spoonful of herbs, pour boiling water over it, leave for about an hour and drink 50 ml three times a day.
- Valerian. In the pharmacy it is found in crushed, dried form, in tablets and in the form of tincture. Valerian relieves pain, normalizes heart rate, has sedative properties. With long-term therapy, it is used as an antidepressant and a remedy for insomnia.
- "Persen". Antispasmodic, antiarrhythmic, sedative drug, normalizes sleep, stimulates appetite. Due to the presence of mint, lemon balm, valerian, there is a clear antiarrhythmic and sedative effect. With the help of "Persen" you can relieve tension, reduce emotional irritability, and also get rid of mental overwork.
- "Novopassit" - a mixture of medicinal herbs such as hops, hawthorn, St. John's wort, lemon balm, elderberry, passion flower. The tool is widely used as an antiarrhythmic drug. As for the dosage, one teaspoon three times a day is enough.
Side effects of antiarrhythmic drugs
Unfortunately, it does not come without negative consequences. Drugs of this spectrum of action have a number of side effects:
- Antiarrhythmics in almost half of the cases are able to act the other way around, that is, to provoke the development of arrhythmia. These so-called arrhythmogenic effects can be life-threatening.
- From the side of the central nervous system, headaches, dizziness, convulsions, fainting, tremor, drowsiness, arterial hypotension, double vision, respiratory arrest may occur.
- With prolonged therapy, bronchospasm, liver failure, dyspepsia are possible.
- Due to the anticholinergic effect after taking group 1 antiarrhythmic drugs in the elderly or in people with poor health, difficulty urinating, spasm of accommodation, dry mouth occur.
- Some of these medicines ("Novocainamide", "Lidocaine", "Amiodarone") can cause allergic reactions, thrombocytopenia, agranulocytosis, drug fever, leukopenia.
Diseases of the heart and blood vessels are often the causes of death, especially in old age. Violation of the functioning of the myocardium leads to the emergence of an impressive list of dangerous diseases, one of which is arrhythmia. This disease should not be allowed to take its course, self-treatment is not allowed. The intervention of a professional is required, who will prescribe a thorough examination of the patient and a full course of antiarrhythmic therapy.
Almost all patients of the cardiologist faced one way or another with various kinds of arrhythmias. Currently, the pharmacological industry offers a wide variety of antiarrhythmic drugs. Their classification and characteristics will be considered in this article.
Ways of exposure
To eliminate ectopic heart rhythm disturbances, antiarrhythmic drugs are prescribed. The mechanism of action of such drugs is aimed at the electrophysiological properties of working myocardial cells:
Classification of antiarrhythmic drugs
All medicines in this group are divided into four classes. Additionally, the first class is divided into three more subclasses. This classification is based on the degree to which drugs affect the ability of heart cells to generate and conduct electrical signals. Different classes of antiarrhythmic drugs have their own routes of action, so their effectiveness will differ for different types of arrhythmia.
The first class includes blockers of fast sodium channels. Subclass IA includes drugs such as Quinidine, Disopyramide, Novocainamide, Gilurithmal. Subclass IB includes Pyromecaine, Tocainide, Difenin, Lidocaine, Aprindine, Trimecaine, Mexiletine. The IC subclass is formed by such agents as Etmozin, Ritmonorm (Propafenone), Allapinin, Etacizin, Flecainide, Indecainide, Bonnecor, Lorcainide.
The second class consists of beta-blockers (Metoprolol, Nadolol, Alprenolol, Kordanum, Propranolol, Acebutalol, Pindolol, Trazikor, Esmolol).
The third class includes potassium channel blockers: Bretilium tosylate, Amiodarone, Sotalol.
The fourth class includes blockers of slow calcium channels (for example, "Verapamil").
The list of antiarrhythmic drugs does not end there. Potassium chloride, sodium adenosine triphosphate, and magnesium sulfate are also isolated.
First class drugs
Blockers of fast sodium channels stop the flow of sodium into the cells, which slows down the passage of the excitation wave through the myocardium. Thanks to this, the conditions for rapid circulation of pathological signals in the heart are stopped, and the arrhythmia is eliminated. Let us consider in more detail the groups of antiarrhythmic drugs belonging to the first class.
Class IA drugs
Such antiarrhythmic drugs are prescribed for and supraventricular), as well as to restore sinus rhythm in case of atrial fibrillation (atrial fibrillation). In addition, they are used to prevent recurrent attacks.
"Novocainamide" and "Quinidine" are effective antiarrhythmic drugs for tachycardia. Let's talk about them in more detail.
"quinidine"
This medicine is used in case of paroxysmal and paroxysmal atrial fibrillation to restore sinus rhythm. Most often, the medicine is prescribed in the form of tablets.
Poisoning with antiarrhythmic drugs is rare, but when taking Quinidine, side effects are possible in the form of indigestion (vomiting, loose stools) and headache. In addition, the use of this medication can cause a decrease in the level of platelets in the blood, a slowdown in intracardiac conduction, and a decrease in myocardial contractility. The most dangerous side effect is the development of a special form of ventricular tachycardia, which can cause sudden death of the patient. That is why Quinidine therapy should be carried out only with the control of the electrocardiogram and under the supervision of a specialist.
The drug is contraindicated in intraventricular and atrioventricular blockade, intoxication with cardiac glycosides, thrombocytopenia, arterial hypotension, heart failure, pregnancy.
"Novocainamide"
This medication has the same indications for use as Quinidine. Quite often it is prescribed for the purpose of stopping paroxysms of atrial fibrillation. With an intravenous injection of Novocainamide, a sharp decrease in blood pressure is possible, as a result of which it is necessary to administer the solution as slowly as possible.
Among the side effects are nausea, vomiting, changes in the composition of the blood, disorders of the nervous system in the form of dizziness, headache, in rare cases, confusion. If you use the drug constantly, a lupus-like syndrome (serositis, arthritis, fever), a microbial infection in the oral cavity, accompanied by slow healing of wounds and ulcers and bleeding gums, may develop. In addition, Novocainamide can provoke an allergic reaction, in this case, the first sign will be the appearance of muscle weakness when the drug is administered.
It is forbidden to use the medication for atrioventricular blockade, severe forms of renal and heart failure, arterial hypotension and cardiogenic shock.
Class IB
Such drugs have little effect on the sinus node, atrioventricular junction and atria, and therefore are ineffective in the case of supraventricular arrhythmias. These antiarrhythmic drugs are prescribed for extrasystole, paroxysmal tachycardia, that is, for the treatment of ventricular arrhythmias. They are also used to treat arrhythmias, which are provoked by an overdose of cardiac glycosides.
The list of antiarrhythmic drugs of this class is quite extensive, but the most commonly used remedy is Lidocaine. As a rule, it is administered intravenously in case of severe ventricular arrhythmias, including myocardial infarction.
"Lidocaine" can disrupt the functioning of the nervous system, which is manifested by dizziness, convulsions, problems with speech and vision, and a disorder of consciousness. If you enter the drug in a large dose, it is possible to slow down the heart rate, reduce the contractility of the heart. In addition, allergic reactions are likely in the form of Quincke's edema, urticaria, skin itching.
"Lidocaine" is contraindicated in atrioventricular blockade, syndrome The drug is not prescribed in case of severe supraventricular arrhythmia, since the risk of atrial fibrillation increases.
IC class
Drugs belonging to this class lengthen intracardiac conduction, especially in the His-Purkinje system. They have pronounced arrhythmogenic properties, so they are currently used to a limited extent.
The list of antiarrhythmic drugs of this class was given above, but of these, only Propafenone (Ritmonorm) is mainly used. It is prescribed for supraventricular and ventricular arrhythmias, including with ERW syndrome. Since there is a risk of an arrhythmogenic effect, the medication should be used under the supervision of a doctor.
In addition to arrhythmias, this drug can cause progression of heart failure and deterioration of cardiac contractility. Side effects include a metallic taste in the mouth, nausea and vomiting. Such negative effects as visual disturbances, changes in the blood test, dizziness, insomnia, and depression are not excluded.
Beta blockers
When the tone of the sympathetic nervous system rises, for example, in case of stress, hypertension, vegetative disorder, ischemia, many catecholamines appear in the blood, including adrenaline. These substances act on myocardial beta-adrenergic receptors, which leads to electrical cardiac instability and the appearance of arrhythmias.
Beta-blockers prevent excessive stimulation of receptors and thus protect the myocardium. In addition, they reduce the excitability of the cells of the conduction system, which leads to a slowdown in the heart rate.
Medicines of this class are used in the treatment of flutter and atrial fibrillation, for the prevention and relief of supraventricular arrhythmias. In addition, they help to overcome sinus tachycardia.
Ineffective considered antiarrhythmic drugs for atrial fibrillation, except in cases where the pathology is caused precisely by an excess of catecholamine in the blood.
For the treatment of rhythm disturbances, Metoprolol and Anaprilin are often used. These drugs have side effects in the form of a slowing of the pulse, a decrease in myocardial contractility, and the occurrence of atrioventricular blockade. These medications can provoke cold extremities and deterioration of peripheral blood flow. In addition, drugs affect the nervous system, causing drowsiness, dizziness, depression, and memory impairment. They also change the conductivity in the nerves and muscles, which is manifested by fatigue and weakness.
Beta-blockers are prohibited for use in cardiogenic shock, pulmonary edema, insulin-dependent diabetes mellitus, bronchial asthma. Also contraindications are atrioventricular blockade of the second degree, sinus bradycardia.
Potassium channel blockers
The list of antiarrhythmic drugs in this group includes agents that slow down electrical processes in the cells of the heart and thereby block potassium channels. The most famous drug of this class is Amiodarone (Cordarone). Among other things, it acts on M-cholinergic and adrenergic receptors.
"Kordaron" is used for the treatment and prevention of ventricular, atrial and supraventricular arrhythmias, heart rhythm disturbances against the background of ERW syndrome. The drug is also prescribed to prevent life-threatening ventricular arrhythmias in patients with acute myocardial infarction. In addition, it is used to reduce the heart rate in persistent atrial fibrillation.
If you use the product for a long time, an interstitial change in skin color (appearance of a purple hue) may develop. In some cases, there are headaches, sleep disturbances, memory, vision. Reception of "Amiodarone" can cause the development of sinus bradycardia, constipation, nausea and vomiting.
Do not prescribe medication for initial bradycardia, prolongation of the Q-T interval, impaired intracardiac conduction, thyroid diseases, arterial hypotension, pregnancy, bronchial asthma.
Blockers of slow calcium channels
These drugs block the slow flow of calcium, thereby suppressing ectopic foci in the atria and reducing the automatism of the sinus node. The list of antiarrhythmic drugs in this group includes "Verapamil", which is prescribed for the prevention and relief of paroxysms of supraventricular tachycardia, for the treatment of supraventricular extrasystoles. "Verapamil" is ineffective in case of ventricular arrhythmias.
Side effects include atrioventricular block, sinus bradycardia, and in some cases, a decrease in cardiac contractility.
cardiac glycosides
The classification of antiarrhythmic drugs will not be complete without mentioning these drugs. These include drugs such as Celanide, Korglikon, Digitoxin, Digoxin, etc. They are used to restore sinus rhythm, stop supraventricular tachycardia, and reduce the frequency of ventricular contractions in case of atrial fibrillation. When using cardiac glycosides, you need to monitor your condition. Signs are manifested by abdominal pain, nausea and vomiting, headaches, visual and sleep disturbances, nosebleeds.
It is forbidden to use these antiarrhythmic drugs for bradycardia, SVC syndrome, intracardiac blockades. They are not prescribed in the case of paroxysmal ventricular tachycardia.
Combination of antiarrhythmic drugs
With ectopic rhythms, some combinations of medications are used in clinical practice. So, "Quinidin" can be used in conjunction with cardiac glycosides for the treatment of persistent extrasystole. With beta-blockers, Quinidine can be prescribed to stop ventricular arrhythmias that are not amenable to other treatment. The combined use of beta-blockers and cardiac glycosides gives a good effect in ventricular and supraventricular extrasystoles, and also helps to prevent recurrence of tachyarrhythmias and ectopic tachycardias.
Whether there is an arrhythmia, where and why it arose, whether it should be treated - only a cardiologist can determine. Only a specialist can understand the variety of antiarrhythmic drugs. The use of many drugs is indicated for narrow pathologies and has a lot of contraindications. Therefore, drugs from this list are not prescribed to themselves independently.
There are a lot of disorders that cause all known types of arrhythmias. Not always they are directly related to the pathology of the heart. But reflected in the work of this important organ, they can cause acute and chronic pathologies of the heart rhythm with a threat to life.
General picture of the occurrence of arrhythmia
The heart does its work under the influence of electrical impulses. The signal is born in the main center that controls contractions - the sinus node. Further, the impulse is transported to both atria along the conducting tracts and bundles. The signal, getting into the next, atrioventricular node, through the bundle of His spreads to the right and left atrium along the nerve endings and groups of fibers.
The coordinated work of all parts of this complex mechanism provides a rhythmic heartbeat at a normal frequency (from 60 to 100 beats per minute). Violation in any area causes a failure, violates the frequency of contractions. Moreover, violations can be of a different order: irregular work of the sinuses, the inability of the muscles to follow orders, impaired conduction of nerve bundles.
Any obstruction or weakness in the signal path also causes the transmission of the command to go according to a completely different scenario, which provokes chaotic, irregular heartbeats.
The reasons for some of these violations have not yet been fully established. Like the mechanism of action of many drugs that help restore the usual rhythm, it is not completely clear. However, many effective drugs for the treatment and urgent relief of arrhythmias have been developed. With their help, most disorders are successfully eliminated or amenable to long-term correction.
Classification of antiarrhythmic drugs
An electrical impulse is transmitted due to the constant movement of positively charged particles - ions. The penetration of sodium, potassium, calcium ions into the cells affects the heart rate (HR). By preventing their passage through special channels in cell membranes, the signal itself can be affected.
Medicines for arrhythmia are grouped not by the active substance, but by the effect produced on the conduction system of the heart. Substances with completely different chemical compositions can have a similar effect on heart contractions. According to this principle, antiarrhythmic drugs (AAP) were classified in the 60s of the 20th century by Vaughan Williams.
The simplest classification according to Williams, distinguishes 4 main classes of AARP and is generally applicable to this day.
Traditional classification of antiarrhythmic drugs:
- Class I - block sodium ions;
- Class II - beta-blockers;
- Class III - block potassium particles;
- Class IV - calcium antagonists;
- Class V - conditional, includes all antiarrhythmic drugs that are not included in the classification.
Even with subsequent improvements, such a division is not considered ideal. But attempts to propose a distinction between antiarrhythmic drugs according to other principles have not yet been successful. Let's consider each class and subclass of AARP in more detail.
Blockers Na- channels (1 class)
The mechanism of action of class 1 drugs is based on the ability of certain substances to block sodium channels and slow down the speed of propagation of an electrical impulse through the myocardium. The electrical signal in arrhythmic disorders often moves in a circle, causing additional contractions of the heart muscle, not controlled by the main sinus. Blocking sodium ions helps to correct just such violations.
Class 1 is the largest group of antiarrhythmic drugs, which is divided into 3 subclasses: 1A, 1B and 1C. All of them have a similar effect on the heart, reducing the number of its contractions per minute, but each has some features.
1A - description, list
In addition to sodium, drugs block potassium channels. In addition to good antiarrhythmic properties, they additionally have a local anesthetic effect, since blocking the channels of the same name in the nervous system leads to a strong anesthetic effect. List of commonly prescribed group 1A drugs:
- Novocainamide;
- Quinidine;
- Aymalin;
- Gilurithmal;
- Disopyramide.
The drugs are effective in stopping many acute conditions: extrasystole (ventricular and supraventricular), atrial fibrillation and its paroxysms, some tachycardias, including WPW (premature ventricular excitation).
Novocainamide and quinidine are used more often than other means of the group. Both drugs are available in tablet form. They are used for the same indications: supraventricular tachycardia, atrial fibrillation with a tendency to paroxysms. But drugs have different contraindications and possible negative consequences.
Due to severe toxicity, many non-cardiological side effects, class 1A is mainly used to relieve an attack, for long-term therapy it is prescribed when it is impossible to use drugs from other groups.
Attention! Arrhythmogenic effects of AARP! In the treatment of antiarrhythmic drugs, in 10% of cases (for 1C - in 20%), the effect is the opposite of the intended one. Instead of arresting an attack or slowing down the frequency of heart contractions, an aggravation of the initial state may occur, fibrillation may occur. Arrhythmogenic effects pose a real threat to life. Reception of any types of AAP should be prescribed by a cardiologist, be sure to take place under his supervision.
1B - properties, list
They differ in the property not to inhibit like 1A, but to activate potassium channels. They are used mainly for pathologies of the ventricles: tachycardia, extrasystole, paroxysm. Most often, they require jet or drip intravenous administration. Recently, many antiarrhythmic drugs of class 1B are produced in the form of tablets (for example, Difenin). The subgroup includes:
- Lidocaine;
- Difenin;
- Meksiletin;
- Pyromecaine;
- Trimecain;
- Phenytoin;
- Aprindin.
The properties of drugs in this group make it possible to use them even with myocardial infarction. The main side effects are associated with significant depression of the nervous system, there are practically no cardiological complications.
Lidocaine is the most famous drug on the list, famous for its excellent anesthetic properties, which are used in all branches of medicine. It is characteristic that the effectiveness of the drug taken orally is practically not observed, it is with intravenous infusion that lidocaine has the strongest antiarrhythmic effect. The most effective jet rapid introduction. Often causes allergic reactions.
1C - list and contraindications
The most powerful blockers of sodium and calcium ions act at all levels of signal transmission, starting from the sinus node. Mainly used internally. Medicines from the group are distinguished by a wide range of applications, they are highly effective in atrial fibrillation, in tachycardia of various origins. Frequently used means:
- Propafenone;
- Flecainide;
- Indecainide;
- Ethacizin;
- Etmozin;
- Lorcainide.
They are used both for rapid relief and permanent treatment of supraventricular and ventricular arrhythmias. Medicines from the group are not applicable for any organic heart disease.
Propaferon (ritmonorm) has only recently become available in intravenous form. It has a membrane-stabilizing effect, exhibits the properties of a beta-blocker, is used for paroxysmal arrhythmias (extrasystoles, atrial fibrillation and flutter), WPW syndrome, atrioventricular tachycardia, as a prophylaxis.
The entire class 1 has limitations in its use in organic myocardial damage, serious heart failure, scars, and other pathological changes in heart tissues. After conducting statistical studies, an increase in the mortality of patients with similar diseases was found during therapy with this class of AARP.
The latest generation of antiarrhythmic drugs, often referred to as beta-blockers, compare favorably with these indicators from class 1 antiarrhythmics and are increasingly being used in practice. The introduction of these drugs into the course of treatment significantly reduces the likelihood of an arrhythmogenic effect of drugs from other groups.
Beta blockers - class II
Block adrenoreceptors, slow down the heart rate. They control contractions in atrial fibrillation, fibrillation, and some tachycardias. They help to avoid the influence of stressful conditions, blocking the ability of catecholamines (in particular adrenaline) to act on andrenoreceptors and cause an increase in heart rate.
After a heart attack, the use of beta-blockers significantly reduces the risk of sudden death. Well proven in the treatment of arrhythmias:
- propranolol;
- metoprolol;
- Cordanum;
- Acebutalol;
- Trazikor;
- Nadolol.
Long-term use can provoke a disorder of sexual function, bronchopulmonary disorders, increased blood sugar. β-blockers are absolutely contraindicated in certain conditions: acute and chronic forms of heart failure, bradycardia, hypotension.
Important! Beta-blockers cause a withdrawal syndrome, so it is not recommended to stop taking them abruptly - only according to the scheme, within two weeks. It is not advisable to skip the time of taking the pills and arbitrarily take breaks in treatment.
There is a significant depression of the central nervous system with prolonged use: memory worsens, depressive states occur, general weakness and lethargy of the musculoskeletal system is noted.
Blockers TO- channels - III class
They block charged potassium atoms at the entrance to the cell. Heart rhythms, unlike class 1 drugs, slow down slightly, but are able to stop long-term atrial fibrillation that lasts for months, where other drugs are powerless. Comparable in action with electrocardioversion (restoration of the heart rhythm with the help of an electric discharge).
Arrhythmic side effects are less than 1%, however, a large number of non-cardiac side effects require constant medical monitoring during treatment.
List of commonly used tools:
- amiodarone;
- Bretylium;
- Sotalol;
- Ibutilide;
- Rephralol;
The most commonly used drug from the list is amiodarone (cordarone), which exhibits the properties of all classes of antiarrhythmic drugs at once and is additionally an antioxidant.
Note!Kordaron can be called the most effective, for today, antiarrhythmic agent. Like beta-blockers, it is the drug of first choice for arrhythmic disorders of any complexity.
Class III antiarrhythmic drugs of the latest generation include dofetilide, ibutilide, and nibentan. They are used for atrial fibrillation, but the risk of pirouette-type tachycardia increases significantly.
The peculiarity of only class 3 is the ability to cause severe forms of tachycardia when taken together with cardiological, other arrhythmic drugs, antibiotics (macrolides), antihistamines, diuretics. Cardiac complications in such combinations can cause sudden death syndrome.
Class IV calcium blockers
By reducing the flow of charged calcium particles into cells, they act both on the heart and blood vessels, and affect the automatism of the sinus node. By reducing myocardial contractions, they simultaneously dilate blood vessels, lower blood pressure, and prevent the formation of blood clots.
- Verapamil;
- Diltiozel;
- Nifedipine;
- Diltiazem.
Class 4 drugs allow you to correct arrhythmic disorders in hypertension, angina pectoris, myocardial infarction. Caution should be used in atrial fibrillation with SVC syndrome. Of the adverse cardiac effects - hypotension, bradycardia, circulatory failure (especially in combination with β-blockers).
Antiarrhythmic drugs of the latest generation, the mechanism of action of which is the blocking of calcium channels, have a prolonged effect, which allows them to be taken 1-2 times a day.
Other antiarrhythmic drugs - class V
Drugs that have a positive effect on arrhythmias, but do not fall into the Williams classification according to the mechanism of their action, are combined into a conditional 5th group of drugs.
cardiac glycosides
The mechanism of action of drugs is based on the properties of natural heart poisons to have a positive effect on the cardiovascular system, provided the dosage is correct. By reducing the number of heartbeats, at the same time increase their efficiency.
Plant poisons are used for urgent relief of tachycardia, are applicable in long-term therapy of rhythm disturbances against the background of chronic heart failure. Slow down the conduction of the nodes, often used to correct flutter and atrial fibrillation. May replace beta-blockers if their use is contraindicated.
List of vegetable glycosides:
- Digoxin.
- Strofanin;
- Ivabradin;
- Korglikon;
- Atropine.
Overdose can cause tachycardia, atrial fibrillation and lead to ventricular fibrillation. With prolonged use, they accumulate in the body, causing specific intoxication.
Salts of sodium, potassium, magnesium
Replenishes the deficiency of vital minerals. They change the balance of electrolytes, allow you to remove the glut of other ions (in particular calcium), lower blood pressure, and calm uncomplicated tachycardia. They show good results in the treatment of glycoside intoxications and the prevention of arrhythmogenic effects characteristic of 1 and 3 classes of AARP. The following forms apply:
- Magnesium sulfate.
- Sodium chloride.
- potassium chloride.
They are prescribed in various forms for the prevention of many cardiac disorders. The most popular pharmaceutical forms of salts: Magnesium-B6, Magnerot, Orocomag, Panangin, Asparkam, Potassium and magnesium asparaginate. On the recommendation of a doctor, a course of drugs from the list or vitamins with mineral supplements may be prescribed to recover from exacerbations.
Adenazine (ATP)
Urgent administration of adenosine triphosphate intravenously stops most attacks of sudden paroxysm. Due to the short period of action, in emergency cases it can be applied several times in a row.
As a universal source of "fast" energy, it provides maintenance therapy for a whole range of cardiac pathologies and is widely used for their prevention. It is not prescribed together with cardiac glycosides and mineral supplements.
ephedrine, isadrine
In contrast to beta-blockers, substances increase the susceptibility of receptors, stimulate the nervous and cardiovascular systems. This property is used to correct the frequency of contractions in bradycardia. Long-term use is not recommended, used as an emergency remedy.
The prescription of classical antiarrhythmic drugs is complicated by the limited ability to predict their efficacy and safety for each individual patient. Often this leads to the need to look for the best option by the selection method. The accumulation of negative factors requires constant monitoring and examinations in the course of treatment.
Antiarrhythmic drugs of the latest generation
In the development of drugs for arrhythmia of a new generation, promising areas are the search for drugs with bradycardic properties, the development of atrio-selective drugs. Some new antiarrhythmics that can help with ischemic disorders and arrhythmias caused by them are at the stage of clinical trials.
Modification of known effective antiarrhythmic drugs (for example, Amiodarone and Carvedilol) is being carried out in order to reduce their toxicity and mutual influence with other cardiac drugs. The properties of agents not previously considered as antiarrhythmics are being studied, this group also includes fish oil and ACE inhibitors.
The goal of developing new drugs for arrhythmia is to produce affordable drugs with the least side effects, and to provide a longer duration of action than existing ones, for the possibility of a once-daily intake.
The above classification is simplified, the list of drugs is very large and is updated all the time. The purpose of each of them has its own reasons, features and consequences for the body. Only a cardiologist can know them and prevent or correct possible deviations. Arrhythmia, complicated by serious pathologies, is not treated at home, prescribing treatment and drugs on your own is a very dangerous occupation.
