Antiarrhythmic agents of plant origin, description. Antiarrhythmic drug with anesthetic properties What antiarrhythmic drugs are used

Cardiac arrhythmia is a disease that, despite the development of its diagnosis and treatment, remains one of the most common. According to statistics, 10 out of 100 people die from this disease. It is difficult to completely get rid of arrhythmia, however, persistent treatment of this disease will significantly reduce the degree of its manifestation and improve the quality of life.

The concept of arrhythmia includes a complex of pathological changes in human health, which is associated with malfunctions of the heart muscle. Each of these disorders is characterized by its own symptoms, such as rhythm disturbance, as well as an increase in contractions of certain parts of the heart, which leads to a sharp deterioration in health. It is worth remembering that any type of arrhythmia requires treatment that is suitable for him, for which specific antiarrhythmic drugs are used.

In a calm and healthy state, the heart contracts 60-80 times within a minute. With arrhythmia, an increase or decrease in this indicator occurs. Treatment of this disease should be aimed not only at getting rid of its symptoms, but also at eliminating the cause that causes abnormal heart rhythm. To do this, the doctor prescribes special antiarrhythmic drugs, which should be taken only under his supervision.

If the number of heart beats is more than 80 units, the patient will begin tachycardia, if less than 60 - bradycardia. Sometimes doctors noticed extrasystoles in patients - additional weak tremors that manifest themselves with a normal heart rhythm. Important: the most severe condition of the patient is atrial fibrillation, in which it is difficult to assess the heart rate, which causes difficulty in breathing.

Causes and symptoms of arrhythmia

A variety of factors can provoke the development of this disease, because even in a perfectly healthy person, the heart rate can change throughout the day. This is directly related to the state and mood of a person, his activity throughout the day, food intake and a certain group of drugs.

But sometimes an irregular heart rhythm can be caused by various diseases, malnutrition and other reasons, among which are the following:

• frequent stressful situations that have a negative impact on the central nervous system;
• brain injury;
• frequent use of certain drugs;
• problems with the violation of the spine;
• hypertension, disruption of the work and condition of blood vessels;
• endocrine pathologies;
• constant exposure to the body of toxins and dangerous components.

The development of arrhythmia consists in a change in the proportional content of calcium, magnesium and potassium in the intracellular environment, which is located in the heart. These changes lead to a serious drop in the work of the heart and its contractile capabilities.

There are different types of arrhythmia, which depend on heart disorders and loss of its functionality. Types of arrhythmias distinguished by medicine:

• Sinus tachycardia
  The main essence of this type of arrhythmia is an increase in the frequency of heart beats, the indicators of which can reach 90-160. Important: such indicators still leave the sinus rhythm normal. The main symptoms are discomfort and burning sensation in the chest, palpitations, slight tingling in the heart muscle.
• Sinus bradycardia
  This diagnosis is made to the patient if the heart rate is 60 beats or less. Despite the fact that this type of pathology often occurs without symptoms, over time, the patient begins to complain of weakness, malaise and lack of strength.
• sinus arrhythmia
  This is the most complex and rare type of arrhythmia, which is characterized by knocking down the sinus rhythm - it constantly increases and decreases. This condition occurs with increased physical activity, which is considered normal and does not require treatment with special drugs, such as antiarrhythmic drugs.

If the heart rhythm is disturbed in the absence of exercise, mandatory treatment is required. To quickly reduce unpleasant and dangerous symptoms, special antiarrhythmic drugs are used to help improve well-being.

With changes in the work of the heart and the appearance of a sharp excitability of the heart muscle, the following types of arrhythmia are distinguished:

1. Extrasystole
   This is an early contraction of a portion of the myocardium, in which strong or weak tremors are observed, as well as a slow heart rhythm. The main symptoms of extrasystole are headache, malaise, general weakness, and the lack of a normal lifestyle.
2. parasystole
   Parasystole makes the focus of excitability of the muscles of the heart heterogeneous, and the symptoms of the disease are mixed.
3. Paroxysmal tachycardia
   Heart rate in the absence of treatment often reaches 140-220 beats, which are counted in 1 minute. The main symptoms that manifest themselves very strongly are persistent tremors in the sternum, shortness of breath, pain in the temples and head, severe fatigue during minimal stress on the body.

Arrhythmia caused by flickering in cardiac activity is divided into the following types, which require specific treatment with a properly selected group of medications. These include the following types:

• Atrial fibrillation
  This is an uncoordinated and very frequent contraction of cells, or rather, their muscles, which are located in one of the atria. The heart rate during flicker reaches 100-150 beats. The main symptoms of the disease are malaise, discomfort in the heart area, signs of heart failure, weakness in the body.
• atrial flutter
  With this diagnosis, the heart rate ranges from 250 to 300 beats. The patient complains of shortness of breath, chest pain and palpitations. This type of arrhythmia in a patient is manifested by a strong contraction of the ventricles. Despite the fact that this type of cardiac pathology is rare today, it is with it that clinical death can occur, because at this moment the body is under severe stress, which is observed when the heart stops or malfunctions.

Rules for the treatment of arrhythmia

In the treatment of arrhythmia, one cannot do without the use of drugs, because it is they who restore the rhythm of the heart and increase its functionality. In order to eliminate the main symptoms of arrhythmia and improve health, you need to follow certain rules:

1. Prevention of thrombus formation
   After a thorough medical examination, the doctor prescribes certain medications, which include Cardiac aspirin, Clopidogrel. Important: these medicines must be taken regularly throughout life. Thanks to the use of these drugs, it will be possible to protect the body from the symptoms and signs of heart attacks and strokes. For the best effect, you can add flaxseeds, garlic, and some other foods to your diet.
2. Strengthening the heart muscle
   Such antiarrhythmic drugs as Riboxin, ATP and Mildronate, etc. increase the resistance of heart cells to frequently developing oxygen deficiency and restore the myocardium. But it must be remembered that antiarrhythmic drugs in each case are prescribed only by a medical professional, who also sets the exact dosage. To increase the level of trace elements in the human body, it is important to add certain foods to the daily diet: honey, fresh vegetables and fruits, nuts and dried fruits. Antiarrhythmic drugs such as Novocainamide, Lidocaine, Ritmilen should be taken regularly. Thanks to this, it is possible to improve the conductivity of cells, which has a beneficial effect on metabolic processes.
3. If the patient has intolerance to antiarrhythmic drugs, the doctor may prescribe the patient tranquilizers - Elenium, Phenazepam, Diazepam, which have a powerful sedative and vasodilating effect.
4. Getting rid of the causes of the development of disorders in the work of the heart will eliminate a dangerous disease and improve health. You should always remember that the treatment regimen for different types of arrhythmias will be different. It is best to seek help from a specialist in this field - a cardiologist, and even better if an arrhythmologist takes care of the treatment of arrhythmia. Very often patients require additional consultation of such specialists as a psychiatrist, endocrinologist and neuropathologist.

How are drugs for the treatment of arrhythmia divided?

There is the following classification of drugs intended for the treatment and prevention of arrhythmia:

• Beta blockers
  They are designed to suppress the mediators of excitation, which often worries patients with arrhythmia. Thanks to their intake, it is possible to reduce the heart rate and normalize their work. These drugs include Propranolol, Carvediol, Atenolol, which are prescribed only according to the doctor's indications.
• Sodium channel blockers
  They help in a short time to normalize the cell membranes located in the heart muscle. Thanks to their use, it is possible to reduce the excitability of muscle cells and reduce their contractions. The main drugs are Lidocaine and Novocainamide.
• Potassium and calcium channel blockers
  This group of drugs increases the refractory period during the absence of impulses that excite the heart. These drugs include Cordaroni Verapamil.

There is also a classification of drugs, thanks to which it is possible to determine in what type of arrhythmia they will be useful. Violation of the proper functioning of the heart, as a result of which heart failures are observed, can be caused by a variety of reasons, so the treatment regimen is selected by the doctor in each case individually.

• The safest and easiest manifestation of arrhythmia is extrasystole. With it, the danger to the body lies only with the development of coronary disease. In the atrial form of arrhythmia, beta-blockers are prescribed, in the ventricular form - Kordaron. Often, the doctor prescribes sedatives to patients in order to normalize the work of the heart.
• To prevent atrial fibrillation, the doctor may prescribe beta-blockers such as Propafenone, Sotahexal, and Novocainamide, which is administered intravenously. The cardiologist prescribes anticoagulants if the patient has an attack for more than 2 days to prevent the risk of developing blood clots and thromboembolism.
• For treatment, antiarrhythmic drugs such as Digoxin are used. Thanks to the restoration of the work of the ventricles, the output from their cavity increases, which helps to reduce the symptoms of heart failure. Important: to quickly cope with the symptoms of atrial fibrillation, it is recommended to use Warfarin.
• With ventricular tachycardia, the patient may suddenly faint, so he will not be able to take the pill. To stop the attack, antiarrhythmic drugs such as Lidocaine and Cordarone are recommended, which are administered intravenously. To prevent repeated attacks, Kordaron is prescribed, which must be used constantly.
• If the main causes are increased physical or emotional stress, then treatment for this condition is not required. If other pathologies are considered the causes of the disease, then the doctor may prescribe medications.
• If the heart rate is low during bradycardia, the patient may faint. Most often, the use of drugs in this case will be ineffective, so Atropine, Dopamine or Adrenaline is administered one-time to restore the normal functioning of the heart rhythm.

Medicines for the treatment of arrhythmias

Before proceeding with the treatment of arrhythmia, it is necessary to undergo a complete medical examination to identify the causes of this disease and its type. In this regard, there is a classification of drugs that are used to treat this unpleasant disease.

Antiarrhythmic drugs should be taken to treat arrhythmias, sedatives should be taken to eliminate coronary insufficiency, and tranquilizers should be used for organic damage to the heart muscle.

1. Sedative drugs

Sedative or sedative medications can be taken as prescribed by a doctor and for the prevention of heart disease. Important: these drugs do not cause side effects, which include drowsiness and addiction, however, we must not forget about the correct dosage.

Sedative drugs reduce the nervousness and mental excitability of the patient, and also lead to the processes of inhibition of the central nervous system.

Sedative medicines include tablets and tinctures created using medicinal herbs and plants.

The main and most common example of sedatives are motherwort and valerian tinctures, which must be taken according to the doctor's indications. Basically, they should be drunk by employees of public institutions and students during exams. But we must not forget about the individual reaction of the body, and if taking sedatives causes a deterioration in well-being, then you need to stop taking them.

Sedatives also include:

• Altalex - it includes lavender, eucalyptus, sage, peppermint, cinnamon and lemon balm essential oils. Such a drug is added to tea, as it was created in the form of a syrup.
• Antares 120 - this drug includes an extract of pepper rhizome, which has a positive effect on the state of the heart muscle.
• Novo-Passit - the composition of the drug includes a whole range of herbs useful for the body - passion flower, St. John's wort, hawthorn, valerian and elderberry.
• Persen - contains in its composition an extract of peppermint and valerian. The medicine is produced in the form of dragees, which must be taken according to the instructions.
• Valocordin - this remedy, which includes phenobarbital, is available in one form - drops. Take patients with coronary insufficiency is not more than 40 drops at a time.
• Sedative collection No. 1 and No. 2 - for heart diseases, they should be taken 50-70 ml 30 minutes before a meal.

2. Tranquilizers

If antiarrhythmic drugs cause individual intolerance, the doctor recommends the use of tranquilizers. They are prescribed for atrial fibrillation, to normalize the heart rate, as well as to quickly equalize it. In addition to the sedative effect, tranquilizers have a powerful hypotensive effect on the patient's body, reduces the heart rate. In the presence of tachycardia, tranquilizers have a vasodilating property.

Important: the dose of a certain drug is prescribed only after an examination conducted by a doctor. An overdose or a minimum dose of the drug can aggravate the course of the disease, so they should be taken according to the strict prescription of a medical worker.

Modern tranquilizers include:

• Xanax
• Medazepam
• Diazepam
• Seduxen

Each of them quickly alleviates the patient's condition and normalizes the heart rhythm. Important: along with these medications, you should not take other drugs that aggravate the effect of the active substance.

If the arrhythmia is caused by an organic lesion of the heart, which leads to coronary insufficiency, treatment with tranquilizers is not carried out, since the condition improves after taking the main drug (antanginal).

3. Antiarrhythmic drugs

Antiarrhythmic drugs are prescribed by doctors for the rapid treatment and prevention of arrhythmias, since this group is able to reduce seizures, relieve them and help reduce pain. This group of drugs has a therapeutic effect on the work and condition of the cells of the body, which leads to an improvement in their patency, functionality and restoration of metabolic processes.

For antiarrhythmic drugs:

• Aimalin - this composition is able to quickly remove the excitability of the myocardium, which causes an increase in heart rate. Aymalin is also prescribed today as an additional treatment.
• Ritmilen - capable of bringing the tone of the heart muscles to a normal state.
• Quinidine - able to normalize the heart rhythm, along with taking other medicines.
• Novocainamide - the composition is able to normalize the general condition of the body and improve heart function, relieving muscle tone.

Important: the dosage of each drug is prescribed by a medical professional, since in each case it is required individually. Taking antiarrhythmic drugs is carried out under the constant supervision of a doctor, as they can act differently on the body. Why is this happening? If the patient has chronic or acute inflammation, the drug will have a negative or weak effect, which is fraught with aggravation of the course of the disease. In other cases, this group of drugs provides a quick and positive treatment.

Antiarrhythmic drugs used in violation of cerebral circulation, venotropic drugs. Antiarrhythmic drugs.

This is a group of drugs used for arrhythmias - conditions characterized by a violation of the rhythm of heart contractions. Arrhythmias are the main cause of death of sick people, which determines the relevance of studying this group of cardiovascular drugs. Arrhythmias can be accompanied by many pathological conditions: for example, 1) metabolic disorders due to circulatory disorders; 2) accompany many hormonal disorders; 3) are the result of various intoxications; 4) are a consequence of the development of side effects of many drugs, etc.

Regardless of the above reasons, heart rate disorders directly occur with pathological changes in such cardiac functions as automatism, conduction, incl. and their combined impairment. Pharmacocorrection of arrhythmias is aimed at normalizing these impaired functions. Given that the automatism and conductivity of the corresponding cells of the conduction system of the heart directly depend on the ion flows that form the action potential of the cells - pacemakers and cells of the conduction system of the heart, this was the basis for the classification of antiarrhythmic drugs.

See the course of physiology for the mechanism of formation of the action potential of pacemaker cells and cells of the conduction system of the heart: which ion flows are which phases of the action potential and where they are formed, which phases of the action potential determine the functions of automatism and conduction, how the phases of the action potential fit into the electrocardiogram.

Classification of antiarrhythmic drugs. Means used for tachyarrhythmias and extrasystoles.

1. Sodium channel blockers:

A. Slowing down depolarization and repolarization: quinidine, procainamide, propafenone, ethmosin, ethacizin, allapinin .

B. Accelerating repolarization: lidocaine.

2. Calcium channel blockers : verapamil.

3. Means that lengthen repolarization: amiodarone, sotalol.

4. Blockers of β-adrenergic receptors: propranolol, metoprolol.

5. Cardiac glycosides: digoxin.

6. Potassium preparations: panangin, asparkam.

Means used for bradyarrhythmias and blockades.

1. Adrenomimetics: isoprenaline, ephedrine, adrenaline.

2. M-anticholinergics: atropine.

Preparations of group 1A have a non-selective membrane-stabilizing effect, thereby suppressing the current of all ions through their channels of cell membranes. This leads to a lengthening of all phases of the action potential, and the refractory period of the cells of the conduction system of the heart is also lengthened. As a result, both the automatism function and the conduction function are simultaneously suppressed in them. This makes the drugs of this group universal, used for both atrial and ventricular tachyarrhythmias.

Quinidine sulfate - available in tablets of 0.1 and 0.2.

The drug is well absorbed when administered orally. In the blood, 87% binds to plasma proteins, incl. with albumins and acidic α 1 - glycoprotein. Therefore, in case of myocardial infarction, the dose of the drug should be increased. Most of the prescribed dose in the liver undergoes oxidation, and only 20% is excreted unchanged in the urine. It should be taken into account that quinidine significantly inhibits cytochrome P450 isoenzyme IID6. T ½ is about 8 hours. The drug is administered orally, in 2 stages. At the saturation stage, it can be administered up to 6 times a day, to maintain the effect, the daily dose is prescribed 3 times a day.

The mechanism of action, see above. In addition to the above, quinidine in a patient can also block α - adrenoreceptors and cause M - anticholinergic action. This contributes to a drop in blood pressure and the development of the so-called piruent tachycardia. As treatment continues and the antiarrhythmic effect of the drug develops, the effect of tachycardia disappears. It should also be borne in mind that with atrial tachyarrhythmias, the M - anticholinergic effect can improve conduction along the A-V node, speeding up the rhythm of ventricular contractions.

O.E. Antiarrhythmic, decrease in heart rate, prolongation of AP and RP, suppression of automatism and conduction.

P.P. 1) Prevention and chronic treatment of patients with atrial tachyarrhythmias: flicker, flutter, tachycardia, paroxysmal tachycardia in the interictal period.

2) Prevention and chronic treatment of patients with ventricular tachyarrhythmias: tachycardia, paroxysmal tachycardia in the interictal period, extrasystole.

P.E. At the beginning of treatment, the development of deadly complications is possible: piruent tachycardia (due to a drop in blood pressure and M - anticholinergic action of quinidine), thromboembolism of vital vessels, especially in the treatment of patients with atrial tachyarrhythmias. This should be anticipated and prevented.

In addition, it is possible to develop bradycardia, a decrease in CCC, a decrease in blood pressure, ringing in the ears, a decrease in hearing acuity, vestibular disorders, headache, diplopia, nausea, vomiting, diarrhea, allergies, sometimes hepatotoxicity, and hematopoiesis suppression. Perhaps the development of cumulation.

Procainamide hydrochloride (novocainamide) - available in tablets of 0.25 and 0.5; in ampoules 10% solution in the amount of 5 ml.

The drug acts and is used similarly quinidine , differences: 1) much weaker, by about 20%, binds to plasma proteins, therefore it acts faster and is used for acute atrial and ventricular tachyarrhythmias; 2) eliminates faster, T ½ is about 3 - 4 hours; 3) metabolized in the liver by the reaction of N - acetylation, so you need to remember about fast and slow acetylators, it is excreted mainly in the urine; 4) does not have α - adrenoblocking and M - anticholinergic effects, but due to the ability to lower blood pressure, the drug is still able to provoke tachycardia at the beginning of treatment, accumulates less, therefore, in general, it is better tolerated, but unlike quinidine, it can often cause severe allergies up to before the formation of the drug lupus erythematosus syndrome, but this is more often manifested in patients with low activity of acetylating enzymes.

Etmozin and its more active derivative ethacizin act and apply like quinidine , differences: 1) expands the coronary vessels, improving cardiac metabolism; 2) are available both in tablets and in solutions for injection, are used for both acute and chronic atrial and ventricular tachyarrhythmias; 3) are better tolerated.

propafenone Available both in tablets and in solution for injection. It is absorbed in the gastrointestinal tract by 100%, but bioavailability due to the pronounced presystemic elimination of this route of administration is 3.4 - 10.6%, which is why oral administration of propafenone is practically not used. In the blood, almost all of it binds to plasma proteins. Metabolized in the liver with the participation of cytochrome P450. Excreted in bile and urine. T ½ It is very individual, and ranges from 5.5 to 17.2 hours in different patients, which, in combination with the above, makes the drug very inconvenient in dosing. In addition, the drug is very poorly tolerated, causing many very serious side effects. Therefore, this drug is rarely used, only for severe ventricular tachyarrhythmias resistant to the use of other antiarrhythmic drugs.

Allapinin - available in tablets by 0.025.

The bioavailability of oral administration of the drug is about 40% due to severe presystemic elimination. The drug penetrates well through the BBB into the central nervous system. Excreted with urine. T ½ is about 1 hour.

The mechanism of action, see above. In general, it can be noted that this is relatively the above means, low in strength, but also a less toxic herbal medicine, a derivative of aconitine.

O.E. 1) decrease in heart rate.

2) expands the coronary vessels, thereby improving cardiac metabolism.

3) sedative.

P.P. 1) Prevention and chronic treatment of patients with atrial tachyarrhythmias.

2) Prevention and chronic treatment of patients with ventricular tachyarrhythmias: tachycardia, paroxysmal tachycardia in the interictal period, extrasystole ..

P.E. Dizziness, headache, diplopia, ataxia, tachyarrhythmia at the beginning of treatment, facial flushing, allergies.

Lidocaine hydrochloride (lidocard) - available in ampoules 2% solution in the amount of 10 ml.

It is administered intravenously, usually by infusion. It is well absorbed in the gastrointestinal tract, but bioavailability due to the pronounced presystemic elimination of this route of administration is almost 0%, which is why oral administration of lidocaine is practically not used. The drug is prescribed mainly in / in, preferably by drip infusion. This is due to the fact that T ½ the drug with a single intravenous injection is about 8 minutes, and therefore a rapid relapse of the pathology is formed. In the blood, 70% binds to plasma proteins, incl. with acidic α 1 - glycoprotein, therefore, in case of myocardial infarction, the dose of the drug should be increased. The drug is metabolized in the liver, excreted mainly in the bile. Final T ½ drug and active metabolites is about 2 hours.

The mechanism of action is associated with blocking the activity of Na + - channels and some activation of K + - channels, resulting in the formation of a state of hyperpolarization of the cell membrane of the cells of the conducting system of the heart. This leads to a prolongation of the diastolic depolarization phase, which leads to a pronounced suppression of the automatism function. Due to some activation of K + - channels, phase 3 of the action potential is accelerated, which, in turn, can lead to a shortening of the refractory period of the cells of the conduction system of the heart. This, firstly, does not allow the conduction function to be suppressed, and secondly, in some cases this function can even improve. Such an action limits the use of lidocaine in atrial tachyarrhythmias due to the fear of the spread of abnormal atrial rhythm to the ventricles, which is extremely unfavorable prognostic.

O.E. Decrease in heart rate due to the lengthening of the action potential and the suppression of automatism. It should be remembered that the refractory period is shortened, which does not suppress, but may even improve the conduction function.

P.P. Acute, life-threatening ventricular tachyarrhythmias, especially those that occur against the background of myocardial infarction.

P.E. bradycardia, lowering blood pressure, reactions of excitation or depression of the central nervous system, depending on the initial state of the patient, allergies.

Amiodarone (Kordaron) - available in tablets of 0.2; in ampoules containing a 5% solution in an amount of 3 ml.

It is prescribed orally, intravenously 1 time per day, when prescribing a saturation dose - more often. The bioavailability of oral administration of the drug is about 30%, due to incomplete absorption. In the blood, almost 100% binds to plasma proteins. Expressed deposited in lipids. It is metabolized in the liver by cytochrome P450 isoenzyme IIIA4. Amiodarone inhibits the activity of microsomal liver enzymes (isoenzymes IIIA4 and IIC9 of cytochrome P450), so the elimination of co-administered drugs can be significantly suppressed. T ½ the drug in adults is about 25 hours, and after discontinuation of the drug can last for weeks, months; children have less. Given the above, the drug should be prescribed in 2 stages. For example, the drug is prescribed 5 days a week, followed by a break of 2 days. Other treatment regimens are also possible. Due to the pronounced connection with plasma proteins and deposition, the effects of the drug develop slowly (weeks, sometimes months), it is prone to cumulation, which makes it difficult to use it correctly.

The mechanism of action of the drug is not exactly clear. It is believed that the drug affects the lipid environment and blocks the ion channels of cell membranes. To a greater extent, K + and Ca 2+ - channels are blocked, which leads to the most pronounced prolongation of the repolarization phase of the action potential of the cells of the conduction system of the heart. The block of Na + - channels is short and insignificant. As a result, the functions of both automatism and conduction are simultaneously suppressed. In addition, the drug dilates the coronary vessels. There are suggestions about its α - or β - adrenergic component of action.

O.E. Decrease in heart rate due to lengthening of the action potential and refractory period, suppression of automatism and slowing of conduction.

P.P. 1) Chronic treatment of patients with atrial tachyarrhythmias: flicker, flutter, tachycardia, paroxysmal tachycardia in the interictal period.

2) Chronic treatment of patients with ventricular tachyarrhythmias: tachycardia, paroxysmal tachycardia in the interictal period, extrasystole.

P.E. bradycardia, some decrease in CCC, lowering blood pressure, nausea, vomiting, bluish skin coloration, discoloration of the iris, photodermatitis, hypo- or hyperthyroidism (a structural analogue of thyroid hormones), neurotoxicity, muscle tissue damage, and allergies can be observed. Sometimes there are fatal complications due to necrosis of hepatocytes, pneumosclerosis of the lungs. The drug clearly accumulates, the risk of overdose and intoxication is high.

Sotalol amiodarone , differences: 1) has a different mechanism of action, it is a non-selective β-blocker; 2) may cause piruent tachycardia in the presence of concomitant hypocardia +emia, see other side effects propranolol .

propranolol - See above for more details. The antiarrhythmic effect is associated with the removal of the heart from the influence of sympathetic innervation and with a compensatory increase in the influence of parasympathetic innervation on the heart. As a result of this, the action potential and the refractory period are lengthened, the automatism function is suppressed and conduction slows down, especially pronounced at the level of the A-V node. The drug is used for both acute and chronic atrial tachyarrhythmias. In case of ventricular arrhythmias, it is recommended only with a concomitant increase in the tone of sympathetic innervation, for example, against the background of hyperthyroidism, with pheochromocytoma, etc.

Metopranolol acts and applies like propranolol , differences: 1) cardioselective agent, better tolerated.

Digoxin - See above for more details. The drug slows down conduction at the level of the A-V node, acting directly and reflexively. But at the same time, due to the + bathmotropic effect, digoxin can stimulate the function of automatism. Therefore, it is used only for atrial tachyarrhythmias in order to prevent the spread of abnormal atrial rhythm to the ventricles, which is extremely unfavorable prognostically, which is why the drug is strictly contraindicated in ventricular tachyarrhythmias.

Panangin - available in pills; in ampoules containing a solution in an amount of 10 ml.

It is a combined drug that is prescribed using the official prescription form. It contains potassium asparaginate (the dragee contains 0.158) and magnesium asparaginate (the dragee contains 0.14). The ampoule contains: K + - 0.1033 and Mg + - 0.0337.

Panangin is prescribed orally, intravenously up to 3 times a day. In / in enter as slowly as possible. Absorbed in the gastrointestinal tract completely and fairly quickly, excreted in the urine by the kidneys.

In the patient's body, it compensates for the lack of K + and Mg + ions. Such a drug is especially relevant in cases where the traditional route of entry of K + ions into the cell is blocked, for example, when exposed to cardiac glycoside preparations. In this case, alternative Mg + - dependent K + - channels are activated, delivering K + into the cell. In the cells of the conduction system of the heart, this leads to a prolongation of the depolarization phase, which lengthens their action potential and refractory period, suppresses the function of automatism, and conduction slows down.

O.E. 1) Compensates for the lack of K + and Mg + ions in the body.

2) Decreases heart rate due to the lengthening of the action potential and the refractory period, the suppression of automatism and the slowing of conduction.

3) improves metabolism in the myocardium.

P.P. 1) Prevention and chronic treatment of patients with hypoK +emia arising, for example, against the background of the use of K + drugs - excretory drugs: saluretics, cardiac glycoside preparations, glucocorticoid hormones, etc.

2) Acute manifestations of hypoKemia.

3) Prevention and chronic treatment of patients with atrial and ventricular tachyarrhythmias.

4) Complex treatment of patients with acute atrial and ventricular tachyarrhythmias.

5) Chronic combined treatment of patients with IHD.

P.E. bradycardia, extrasystole, lowering blood pressure, nausea, vomiting, diarrhea, heaviness in the epigastrium, the phenomena of hyperK + - and hyperMg 2+ - emia, CNS depression to coma, incl. respiratory depression, convulsions.

Asparkam acts and applies like panangina , differences: 1) domestic, cheaper remedy.

With bradycardia, pharmacotherapy is almost never practiced; in some cases, the technique of implanting pacemakers is used. Medicines are used as a means of providing emergency care with a pronounced manifestation of A-V blockades. It should be remembered that with the development of such a pathology against the background of a pronounced increase in parasympathetic influences, for example, with intoxication with cardiac glycoside preparations, it is more competent to use atropine sulfate. For a more detailed description of the drugs named in the classification, see yourself in previous lectures.

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:

1. Through cardiomyocytes, the movement of sodium, potassium and chlorine ions occurs.
2. Due to the movement of these particles, an action potential is formed - an electrical signal.
3. In a healthy state, cardiomyocytes contract in synchrony, so the heart works normally.
4. 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 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 arrhythmia

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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To normalize the heart rhythm, drugs belonging to completely different types of medications are used. But their effectiveness is based on the possibility of influencing the permeability of cell walls.

The myocardium and the cardiac conduction system consist of cells with a large number of channels in their walls. Through them, the circulation of sodium, potassium, chlorine and other components in both directions is carried out.

This movement generates an electrical charge, that is, a potential that provides contractions of the heart muscle. When the movement of ions through the walls through the channels is disturbed, pathological impulses arise that provoke the development of arrhythmia.

If the heart begins to "go astray", the use of special drugs stops the movement of ions through the walls and leads to their blockade. The pathological signal is interrupted, the organ restores its normal rhythm, and the manifestations of the problem disappear. The patient feels much better.

Classification

All antiarrhythmics are divided according to different principles: by the effect on the heart muscle, on innervation, acting in both directions, but the most common is the division into classes:

• Class 1A - membrane stabilizers, that is, agents that restore the normal function of cell walls. These include Quinidine, Novocainamide, Disopyramide, Giluritmal and others.
• Class 1B - drugs that increase the duration of the action potential. These are Lidocaine, Pyromecaine, Trimecaine, Tocainide, Mexiletine, Difenin, Aprindin.
• Class 1C - calcium ion antagonists, or calcium channel blockers. This class includes drugs such as Etatsizin, Etmozin, Bonnecor, Propafenone (Ritmonorm), Flecainide, Lorcainide, Allapinin, Indecainide.

First-class drugs are prescribed for extrasystole, ventricular and atrial fibrillation, paroxysmal tachycardia.

• Class 2 - beta-blockers: Propranolol, Metoprolol, Acebutalol, Nadolol, Pindolol, Esmolol, Alprenolol, Trazikor, Kordanum. Drugs of this type are useful for and can reduce the risk of developing. Cardioselective drugs include Epilok, Atenolol and others. Propranolol has an antianginal effect.
• Class 3 - potassium channel blockers: Cordarone (Amiodarone), Bretylium tosylate, Sotalol.
• Class 4 - blockers of slow calcium channels: Verapamil.

All drugs of this type must be carefully selected for patients who have additional heart problems such as bradycardia, bradyarrhythmias,
and other violations.

Other drugs

In cases where antiarrhythmic drugs belonging to the first four classes turn out to be ineffective or require additional exposure, drugs are used that are allocated by some authors to a separate, fifth class. It includes the following tools:

• Potassium preparations. The lack of this mineral leads to changes in heart rate, shortness of breath, muscle weakness, especially of the lower extremities, convulsions and paresis, intestinal obstruction. Patients are prescribed potassium in the form of the following drugs: Panangin or Asparkam, Asparginate, Potassium orotate, Orokamag, Kalinor and others.
• cardiac glycosides. This is a group of drugs for the treatment of different origins. They have antiarrhythmic and cardiotonic effects, improve myocardial performance. The preparations are based on vegetable raw materials, a derivative of such medicinal herbs as foxglove purple and woolly (Digitoxin and Digoxin), May lily of the valley (Korglikon), spring adonis (Adonis-bromine), Combe strophanthus (Strophanthin K). Medicines can be dangerous in large quantities, as all of the listed plants are poisonous. When treating, it is necessary to strictly follow the dosage. Glycosides are not used in some forms of arrhythmias, as they can cause ventricular extrasystole, and overdose leads to ventricular fibrillation.
• Adenosine This drug is administered intravenously and causes a temporary blockade of the atrioventricular node of the heart. The tool acts almost instantly - the effect appears within 20-30 minutes. Adenosine is used to stop tachycardia attacks.
• Magnesium sulfate (magnesium, Epsom salt). It is a mineral white powder with a lot of useful properties. The drug is widely used and used for various purposes. It has the following actions: vasodilator, analgesic, antispasmodic, anticonvulsant, antiarrhythmic, choleretic, diuretic, laxative, sedative. With antiarrhythmic purposes, the drug is administered mainly intravenously.

Since arrhythmias often provoke thrombosis, doctors prescribe a number of auxiliary drugs aimed at thinning the blood. The most famous is Aspirin, or acetylsalicylic acid. It has not only antithrombotic properties, but also has an anti-inflammatory, analgesic effect.

Latest generation products

Every year, the pharmaceutical industry produces more and more new antiarrhythmic drugs, which often use already used formulations, only better and more advanced. The emergence of many generics under new names, which are actually well-known drugs with a similar composition, also introduces confusion.

This once again indicates the need for the mandatory appointment of such funds by the attending physician and their individual selection through trial and error. What works perfectly for one patient may be completely ineffective for another.

The group of drugs actively prescribed by doctors includes Amiodarone, Aritmil Cardio, Cardiodaron, Kordaron, Mioritmil, Rotaritmil, Propranolol, Ritmonorm, Verapamil and many other drugs.

Since such medicines are selected individually, there is no single treatment regimen that is suitable for absolutely all patients, even if they have one disease with similar symptoms.

Herbal preparations

If you do not take into account cardiac glycosides, the list of herbal preparations that can have a positive effect on heart rate will be supplemented by the following remedies:

• Valerian. This plant has a pronounced sedative effect, calms uneven heart rate and promotes general relaxation, helps restful sleep. You can buy valerian in different forms. In the pharmacy, the remedy is presented in the form of tablets, including Forte, as an alcohol tincture, and there is also the opportunity to buy dried plant roots and brew it yourself. It is not recommended to take valerian for a long time, as it can itself provoke overexcitation and an increase in heart rate if it is abused for a long time or if the dosage is arbitrarily increased.
• Motherwort. Preparations based on this plant are able to reduce the excitation of the central nervous system, have a sedative and mild hypnotic effect, lower blood pressure and have a moderate cardiotonic effect. They can be used for a long time as additional funds or as maintenance therapy, as they do not cause addiction and dependence. Like valerian, motherwort is available in pharmacies in various forms, including tablets, alcohol tincture and herb.
• Hawthorn. The flowers and fruits of this shrub are good for the heart and have an antihypoxic effect.
• Novopassit. This drug has a pronounced sedative effect and is successfully used for the prevention and treatment of arrhythmia as an adjuvant. It is based on a complex of plant extracts and extracts. Apply 1 teaspoon three times a day.
• Persen. Another herbal remedy, which includes herbs well known for their calming effect on the nervous and cardiovascular systems. These are peppermint, lemon balm and valerian root. They have a sedative, antispasmodic and antiarrhythmic effect on the body with a minimum number of contraindications and restrictions.

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 arrhythmia. 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 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 the strong 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 sexual dysfunction, 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:

1. Digoxin.
2. Strofanin;
3. Ivabradin;
4. Korglikon;
5. 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 oversaturation with 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:

1. Magnesium sulfate.
2. Sodium chloride.
3. 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 supportive 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.

Known effective antiarrhythmic drugs (eg Amiodarone and Carvedilol) are being modified to reduce their toxicity and interactions 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.