From this article you will learn: what are the antiarrhythmic drugs, which drugs are best suited for each specific case of arrhythmia.
Amiodarone - the first-line universal drug
Medical treatment of arrhythmia is the main treatment for this disease. In 90-95% antiarrhythmic drugs allow either to completely eliminate the arrhythmia, or reduce its severity. They are equally effective in both emergency and systematic care, aimed at preventing repeated disruption of the rhythm. But in order to achieve the maximum result of treatment it is important to know what preparations should be used in those or other cases.
Below is a list of the most effective and safe drugs that are most often used to treat cardiac arrhythmias( in order of decreasing effectiveness):
- Potassium channel blockers - Amiodarone( its analogue is Cordarone, Arithmil).
- Beta blockers - Metoprolol( Corvitol), Bisoprolol( Concor), Nebivalol.
- Calcium channel blockers - Verapamil( Isoptin, Finoptin).
- Local anesthetics - Lidocaine, Novokainamide.
- Drugs of different groups:
- cardiac glycosides - Strofantin, Korglikon, Digoxin;
- medications containing potassium - Panangin, Asparcum.
A cardiologist is involved in the selection, prescription of antiarrhythmic drugs and control over their effectiveness, but the therapist and the family doctor can also.
Amiodarone is the universal first-line drug
Amiodarone is considered to be the number one agent for any cardiac arrhythmias among all preparations for the treatment of arrhythmia. It is equally suitable for use in the ambulance mode, when the patient urgently needs to remove the attack, and for maintenance treatment, preventing repeated heartbeat interruptions.
When is the most effective: indications
Classical indications for the appointment of amiodarone:
- atrial fibrillation;
- atrial fibrillation and flutter;
- supraventricular and ventricular extrasystole;
- pronounced sinus tachycardia( paroxysmal);
- Wolff-Parkinson-White syndrome.
Forms and preparations of analogs
Amiodarone is both an active substance and a medicamentous preparation. There are analogues - antiarrhythmic drugs containing an identical basis, but having a different name. Basically, two drugs are used:
- Cordarone,
- Aritmil.
Both amiodarone and its analogs are available as tablets and injectable solutions( intravenous injections).
Features of the action and dignity of the drug
Amiodarone has a unique mechanism of action - it blocks the channels through which the transport of potassium ions in the heart. Due to this, the general exchange of electrolytes, primarily sodium and calcium, is slowed down. Against this background, the excitability of the myocardium and the conduction system of the heart decreases - less often impulses appear for contraction and their conductivity decreases.
The main advantage of amiodarone is its antianginal effect. This means that the drug improves blood flow to the myocardium by reducing the need for oxygen and directly expanding the coronary arteries.
Tips for using
Practical recommendations:
- If a person has an attack of rapid irregular heartbeats, amiodarone can be administered regardless of which particular arrhythmia.
- Due to the antianginal effect, amiodarone is the drug of choice for severe arrhythmias, combined with coronary heart disease, hypertrophy and a decrease in contractility of the left ventricle, heart failure.
- Such antiarrhythmic drugs act slowly, but for a long time, while injections on the contrary - quickly but briefly. Therefore, for rapid relief of attacks of arrhythmia and within a few days after it, amiodarone is best administered intravenously( dropper, or slow injection), and to maintain a constant concentration of the active substance in the blood better tablets.
- In view of the strong inhibitory effect on the heart is contraindicated in the combination of arrhythmias with conduction disorders( atrioventricular blockade).
- Does not affect the level of blood pressure, therefore it is the only way to help patients with arrhythmias, accompanied by a decrease in blood pressure or myocardial infarction.
- Drug tolerance is good, and side effects are rare, which allows for frequent and prolonged use.
The only minus of
Amiodarone does not have a sufficient therapeutic antiarrhythmic effect for the reduction of ventricular fibrillation and other severe ventricular arrhythmias. Preference in such cases is given to local anesthetics - Lidocaine and Novokainamid.
Sinus rhythm of the heart on the ECG: various types of ventricular fibrillation Beta-blockers: how to apply them correctly
The meaning of the appointment of beta-blockers in arrhythmias is the mechanism of their action on the heart. These drugs bind to the beta receptors, through which adrenaline exercises its stimulating effects on the myocardium - increases the frequency of contractions. Blocking the receptors with medications, you can eliminate this effect, which is important in the treatment of arrhythmia.
The most common medications of this group are: Metoprolol and Bisoprolol. Compared with Amiodarone, as a reference antiarrhythmic drug, they are weaker, but in some cases they can not be avoided. This is due to additional effects - the expansion of the coronary arteries and a decrease in blood pressure. Therefore, any beta-blocker is considered a drug of choice when combined with light supraventricular and atrial fibrillation, ventricular extrasystoles with:
- hypertensive disease;
- ischemic heart disease;
- disorders of cerebral circulation.
What is good Metoprolol
The advantage of metoprolol( the name of the analogue is Corvitol), which makes it one of the main drugs for first aid in arrhythmias, is a fairly rapid onset of the therapeutic effect - even if such pills are used for arrhythmia. The active substance, when taken under the tongue, accumulates in the blood in therapeutic concentration after 30-40 minutes. Therefore, it is mainly used to stop attacks and in the immediate period after it.
Why Bisoprolol
Medication for arrhythmia of the heart Bisoprolol( the list of analogues: Concor, Biprolol) acts slowly, gradually, but continuously( about 12 hours).This feature, combined with the pronounced effects characteristic of beta-blockers, allow the use of the drug for prolonged treatment and prevention of repeated heart rate disruptions.
Disadvantages of beta blockers
Antiarrhythmic agents beta-blockers can not be prescribed for the treatment of arrhythmias in patients:
- Chronic obstructive lung diseases and bronchial asthma.
- With low blood pressure. This is very important, since about 50% of heart attacks and 20% of arrhythmic attacks are accompanied by a similar violation.
- Pronounced heart failure.
- No injectable formulations.
Click on the picture to enlarge Verapamil - the ideal drug for supraventricular arrhythmia
The mechanism of antiarrhythmic action of verapamil is associated with a slowing of the transport of calcium ions to the heart. Thanks to this:
- decreases the excitability of the myocardium and the conductive system;
- decreases the frequency of cuts;
- decreases total blood pressure.
The key feature is that cardiac effects are expressed exclusively in the supraventricular zone - atria and sinus node. Therefore, Verapamil and its analogues( Isoptin, Finoptin) are mainly used in fibrillation and atrial fibrillation, supraventricular extrasystoles. It is especially relevant if such arrhythmias are combined with increased blood pressure or angina.
Produced as an intravenous injection solution, which is convenient for the elimination of an attack, and in tablets, which allows it to be used to prevent relapse.
Local anesthetics - when to use
Local anesthetics( lidocaine and Novokainamide), in addition to the anesthetic effect, have antiarrhythmic effects. Most of all, it is expressed in relation to the ventricles of the heart. None of the existing means for the treatment of arrhythmia does not have a similar effect.
Both Novokainamide and Lidocaine are available only in injectable form. They are administered intravenously in exceptional cases with ventricular arrhythmias - fibrillation and ventricular fibrillation, frequent ventricular extrasystoles. Act immediately after the introduction, but for a short time. Effective, but not devoid of side effects in the form of allergic reactions.
Auxiliary drugs that help with arrhythmia
For light attacks of atrial fibrillation, paroxysmal tachycardia, supraventricular and ventricular extrasystole, a sufficient curative effect can be obtained from:
- preparations containing potassium and magnesium ions - Aspakam, Panangin;
- cardiac glycosides - Strofantin, Corligicon, Digoxin.
For urgent treatment, both are administered intravenously: Asparcum and Panangin drip, and glycosides are jet( slow intravenous injection).The mechanism of action is associated with the slowing of the transport of sodium ions into the cells, reducing its excitability and increasing the contractility. These drugs are also available in tablets, but their antiarrhythmic effect is poorly expressed, longer with prolonged admission.
Even if you know the names of the drugs, this does not give you the right to use antiarrhythmics without the advice of a specialist!
