心血管治疗药物综述

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1、PharmacologyDrugsthatAffecttheCardiovascularSystemTopicsElectrophysiologyVaughn-WilliamsclassificationAntihypertensivesHemostaticagentsCardiacFunctionDependentuponAdequateamountsofATPAdequateamountsofCa++CoordinatedelectricalstimulusAdequateAmountsofATPNeededto:Maintainelectrochemicalgrad

2、ientsPropagateactionpotentialsPowermusclecontractionAdequateAmountsofCalciumCalciumis‘glue’thatlinkselectricalandmechanicalevents.CoordinatedElectricalStimulationHeartcapableofautomaticityTwotypesofmyocardialtissueContractileConductiveImpulsestravelthrough‘actionpotentialsuperhighway’.A.P

3、.SuperHighwaySinoatrialnodeAtrioventricularnodeBundleofHisBundleBranchesFasciclesPurkinjeNetworkElectrophysiologyTwotypesofactionpotentialsFastpotentialsFoundincontractiletissueSlowpotentialsFoundinSA,AVnodetissuesFastPotential-80-60-40-200+20RMP-80to90mVPhase1Phase2Phase3Phase4controlled

4、byNa+channels=“fastchannels”FastPotentialPhase0:Na+influx“fastsodiumchannels”Phase1:K+effluxPhase2:(Plateau)K+effluxANDCa++influxPhase3:K+effluxPhase4:RestingMembranePotentialCardiacConductionCycleSlowPotential-80-60-40-200Phase4Phase3dependentuponCa++channels=“slowchannels”SlowPotentialS

5、elf-depolarizingResponsibleforautomaticityPhase4depolarization‘slowsodium-calciumchannels’‘leaky’tosodiumPhase3repolarizationK+effluxCardiacPacemakerDominanceIntrinsicfiringrates:SA=60–100AV=45–60Purkinje=15-45CardiacPacemakersSAisprimaryFasterdepolarizationrateFasterCa++‘leak’Othersare‘b

6、ackups’GraduateddepolarizationrateGraduatedCa++leakratePotentialTermsAPDERPRRPrelativerefractoryperiodeffectiverefractoryperiodactionpotentialdurationDysrhythmiaGenerationAbnormalgenesisImbalanceofANSstimuliPathologicphase4depolarizationEctopicfociDysrhythmiaGenerationAbnormalconductionAn

7、alogies:OnewayvalveBuggiesstuckinmuddyroadsReentrantCircuitsWarning!AllantidysrhythmicshavearrythmogenicpropertiesInotherwords,theyallcanCAUSEdysrhythmiastoo!AHARecommendationClassificationsDescribesweightofsupportingevidenceNOTmechanismClassIClassIIaClassIIbIndeter