临床药理Arrhyth

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1、治疗心律失常药物Antiarrhythmicagents一、BasicConcept正常心率（窦性心律）：Theelectricalimpulsethattriggersanormalcardiaccontractionoriginatesatregularintervalsinthesinoatrialnode,usuallyatafrequencyof60-100beatsperminute.Thisimpulsespreadsrapidlythroughtheatriaandenterstheatrioventricularnode,thenprop

2、agatesovertheHis-Purkinjesystemandinvadesallpartsoftheventricles.心律失常：Arrhythmiasconsistofcardiacdepolarizationsthatdeviatefromtheabovedescriptioninoneormoreaspects—ie,thereisanabnormalityinthesiteoforiginoftheimpulse,itsrateorregularity,oritsconduction。心律失常分类总的可分快速型和过缓型（然后根据发生部位和性

3、质再分）快速型：房早，房速，房颤；室早，室速，室颤过缓型（缓慢型）：房室传导阻滞，束支传导阻滞，窦性心动过缓等，阿托品，拟肾上腺素药物等有一定作用。心律失常的治疗学分类就临床治疗的观点，心律失常可分为三类：良性（无器质性病变）benignarrhythmias:VPBs,sinustachycardiausingAnxiolyticsandSedatives可能恶性（轻中度器质性病变）potentialmalignantarrhythmias：ParoxysmalSupraventricularTachycardia,monomorphicventricul

4、artachycardia,atrialfibrillation恶性（重度器质性病变）malignantarrhythmias(life-threateningarrhythmias)：sustainedventriculartachycardia,polymorphicventriculartachycardia,ventricularfibrillation二、PathophysiologyArrhythmiasdevelopbecauseofabnormalimpulsegeneration,abnormalpropagationorbothBrady

5、arrhythmiasWhicharisethroughabnormalitiesofintrinsicautomaticbehaviororconduction,principallywithintheatrioventricularnodeandtheHis-Purkinje'snetwork.TachyarrhythmiasThreemechanismshavebeenassociatedwithmanytachyarrhythmiasAlteredautomaticity:Factorsthatincreaseautomaticityincludem

6、echanicalstretchbeta-adrenergicstimulationhypokalemiaTriggeredautomaticity:EarlyAfterdepolarization(EAD)早后除极whichisassociatedwithsignificantprolongationoftheactionpotentialduration.FactorsthatpredisposetoEAD:bradycardialowextracellularK+certaindrugs,includingsomeantiarrhythmicsTors

7、adesdepointes,apolymorphicventriculararrhythmia-associatedwithProlongationofcardiacrepolarization(prolongedQ-Tinterval)PossiblyinducedbyearlyafterdepolarizationsDelayedafterdepolarization(DAD)迟后除极.FactorsthatpredisposetoDADinclude:excessiveadrenergicactivitydigitalistoxicityhighint

8、racellularCa2+reentry:Most