tailieunhanh - Antiarrhythmic Drugs A practical guide – Part 3

Nếu EAD đạt đến ngưỡng tiềm năng của các tế bào tim, điện thế hoạt động khác được tạo ra và loạn nhịp tim xảy ra. EADS nói chung là nhìn thấy chỉ trong những trường hợp kéo dài thời gian của điện thế hoạt động, chẳng hạn như bất thường điện giải (hạ kali máu và hypomagnesemia) | Mechanisms of cardiac tachyarrhythmias 31 phase 3 of the action potential hence they are called early afterdepolarizations EADs see Figure . If the EAD reaches the threshold potential of the cardiac cell another action potential is generated and an arrhythmia occurs. EADs are generally seen only under circumstances that prolong the duration of the action potential such as electrolyte abnormalities hypokalemia and hypomagnesemia and with the use of certain drugs that cause widening of the action potential predominantly antiarrhythmic drugs Table . Table Drugs that can cause torsades de pointes Class I and Class III antiarrhythmic drugs Quinidine Procainamide Disopyramide Propafenone Sotalol Amiodarone Bretylium Ibutilide Tricyclic and tetracyclic antidepressants Amitriptyline Imipramine Doxepin Maprotiline Phenothiazines Thioridazine Chlorpromazine Antibiotics Erythromycin Trimethoprim-sulfamethoxazole Others Bepridil Lidoflazine Probucol Haloperidol Chloral hydrate 32 Chapter 1 It appears that some finite subset of the apparently normal population is susceptible to developing EADs. These patients from available evidence have one of several channelopathies that become clinically manifest only when their action potential durations are increased by drugs or electrolyte abnormalities. The ventricular arrhythmias associated with EADs are typically polymorphic and most often occur repeatedly and in short bursts although prolonged arrhythmic episodes leading to syncope or sudden death can occur. The repolarization abnormalities responsible for these arrhythmias . the afterdepolarizations are reflected on the surface ECG where the T-wave configuration is often distorted and a U wave is present. The U wave is the ECG manifestation of the EAD itself. The T-U abnormalities tend to be dynamic that is they wax and wane from beat to beat mainly depending on beat-to-beat variations in heart rate. The slower the heart rate the more exaggerated the T-U abnormality

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