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TREATMENT OF ARRHYTHMIAS

Antiarrhythmic agents depending on their mechanism of action are subdivided into classes (Table 13).

Table 13 Classification of antiarrhythmic preparations

I class — blockers of fast sodium channels.

A typical representative of IA class is quinidine sulfate prescribed per os by 0.8-2.0 a day for several intakes. Here, we refer novocainamide that is introduced intravenously at the rate of 50 mg/min slowly under control of pulse and AP in the dosage of 0.25-0.25-0.25-0.25 with the 5-min intervals. If the effect is achieved one should proceed to maintenance doses per os by 0.25-0.5 every 4-6 hours.

Among the preparations of IB class 2% lidocaine is administered as a SO­YS mg bolus, and after the start of its effect — drop-by-drop 100-120 mg. A daily dose should not exceed 700 mg. Piromecaine, trimecaine, dipheninum and others have the same effect.

Ethmozin (introduced by 50-150 mg intravenously) is referred to IC and is the most effective in ventricular arrhythmias, disopyramide or rytmilen (per os 0.1-0.2 3 times), ajmalin (in tablets and ampules 2.5% solution 2 ml) are recommended to arrest the attacks of ciliary arrhythmia and paroxysmal tachycardia.

II class — /3-adrenoblockers decreasing influence of adrenergic impulses
on the heart. Among them are trasicor, obsidan, inderal that are administered
in the dose of 0.08-0.15 mg/kg at the rate of 1 mg/min. Maintenance dose is
160 mg/day.

III class — potassium channels blockers increasing an action potential and slowing down repolarization: ornid 2-5 mg/kg intravenously slowly, amyodaron and others.

IV class — slow calcium channels blockers: verapimil, isoptin and others. They cannot be applied in cardiogenic shock (hypotension is intensified), after application of/?-blockers (a danger of collapse and asystole) and in fluothane narcosis (may cause A-V blockade).

As for the preparations of V and VI classes, in recent years they are getting rare to be applied to arrest arrhythmia.

In elevation of n. vagus tone atropine, methacinum, adrenomimetics — adrenalin, ephedrine, isadrin, alupent are applied.

There are also substances improving myocardial metabolism and having a positive effect on cardiac rhythm:

— Cocarboxylase 200-300 mg in polarizing solution;

— Panangin (it is K⁺+ Mg⁺⁺ + aspartic acid that decreases K⁺ permeability into the cell);

— Cytochrome C;

— Alkalizing solutions (soda andTris buffer), preparations binding calcium (tetacin Mg, magnesium sulfate).

Medicinal preparations recommended in cardiac rhythm disorders are presented in Table 14.

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