Cardiac Arrhythmia and its treatmentSeminar report submitted in partial fulfillment for the award of degree of

B.Pharm (6th Sem, 3rd Year).

By Mr. Souvik Pal Regd. No: 131740210056 Roll No: 17401913054 NETAJI Subhas Chandra bose institute of pharmacy (Affiliated by MAKAUT)

ContentsA.Introduction

B. Epidemology C. Genetics in Cardiac Arrhythmia

D.PathophysiologyE.Sign and Symptoms

F. Drugs treatment for Cardiac Arrhythmia

IntroductionThe term "arrhythmia" refers to any change from the normal sequence of electrical impulses. The electrical impulses may happen too fast, too slowly – causing the heart to beat too fast, too slowly. When the heart doesn't beat properly, it can't pump blood effectively. When the heart doesn't pump blood effectively, the lungs, brain and all other organs can't work properly and may shut down or be damaged. Arrhythmias are nothing but abnormal beats. The term "arrhythmia"

refers to any change from the normal sequence of electrical impulses, causing abnormal heart rhythms. Arrhythmias may be completely harmless or life-threatening.

Some arrhythmias are so brief (for example, a temporary pause or premature beat) that the overall heart rate or rhythm isn't greatly affected. But if arrhythmias last longer, they may cause the heart rate to be too slow or too fast – so the heart pumps less effectively.

A fast heart rate (in adults, more than 100 beats per minute) is called tachycardia

A slow heart rate (less than 60 beats per minute) is referred to as bradycardia.

EpidemiologyCardiac arrhythmia generally refers to an unexpected death from a cardiovascular cause in a person with or without preexisting heart disease. Structural heart disease in cardiac arrest survivors. These bar

charts depict the proportions of underlying cardiac disease among men and women who survive out-of-hospital cardiac arrests. The mean age was 58±12 years for men and 55±17 years for women. 

Coronary artery disease was the principal diagnosis in the majority of men. In contrast, women had more heart disease than men, including dilated cardiomyopathy (19%) and valvular heart disease (13%).

Genetics of Cardiac ArrhythmiaThese remarkable advances stemmed from the discovery of mutations, primarily in ion channel genes, underlying a number of these disorders. Herein review these developments at very short, Long QT Syndrome ------

Repolarization is a delicate process depending on the intricate balance between inward currents (sodium, Na+, or calcium, Ca2+) and outward current (Potassium, K+). QT interval is long. KCNQ1 is involved for LQTS.

Short QT Syndrome ------- Repolarization is a delicate process depending on the intricate balance between inward currents (sodium, Na+, or calcium, Ca2+) and outward current (Potassium, K+). QT interval is short. KCNH2 is involved for SQTS.

Brugada Syndrome ----- Brugada Syndrome is genetic disease is charactarised by abnormal ECG findings 20% of the case of a mutations in gene that encodes for a sodium ion channels in the cell membranes. The gene is SCN5A is located on the short arm of the third chromosome.

PathophysiologyThe arrhythmias falls into one of the four basic mechanism : Automaticity, Re-

entry, Fibrillation, Triggered activity. Automaticity- Automaticity refers to a cardiac muscle cell firing off an impulse

on its own. These cells are found in the conduction system of the heart and include the SA node, AV node, Bundle of His and Purkinje fibers. It can produce a sustained abnormal rhythm.

Re-entry- Re-entrant arrhythmias occur when an electrical impulse recurrently travels in a tight circle within the heart, rather than moving from one end of the heart to the other and then stopping. Every cardiac cell is able to transmit impulses of excitation in every direction. Re-entry is also responsible for most paroxysmalsupraventricular tachycardia, and dangerous ventricular tachycardia. 

Fibrillation- When an entire chamber of the heart is involved in multiple micro-reentry circuits and is therefore transmitting the impulse it is called as Fibrillation.

Triggered Activity

Sign and Symptoms The term cardiac arrhythmia covers a very large number of very different

conditions. The most common symptom of arrhythmia is an abnormal awareness of heartbeat, called palpitations. These may be infrequent, frequent, or continuous. Some of these arrhythmias are harmless.

Some arrhythmias do not cause symptoms, and are not associated with increased mortality. Examples include a higher risk of blood clotting within the heart and a higher risk of insufficient blood being transported to the heart because of weak heartbeat.

If an arrhythmia results in a heartbeat that is too fast, too slow or too weak to supply the body's needs, this manifests as a lower blood pressure and may cause lightheadedness or dizziness, or syncope (fainting).

Noticeable arrhythmia symptoms may include: A fluttering in your chest A racing heartbeat (tachycardia) A slow heartbeat (bradycardia) Chest pain Shortness of breath Sweating

Anti arrhythmic Drugs Classification (Based on mechanism of action)

Anti arrhythmic Drugs Class I Drugs (Na+ Channel blockers)

Class Known as Examples Mechanism

I(Ia,Ib,Ic)

Membrane stabilizing agents (Na+ Channel blockers)

QuinidineDisopyramideLidocaineTocainideFlecainidePropafenone

(Na+) channel block (intermediate association/dissociation) and K+ channel blocking effect.

Sodium (Na+) Channel Blocker

Anti arrhythmic Drugs Class II Drugs ( β blockers )

IIAntiadrenergic Agents (Beta-blockers)

Solatolol Propranolol

beta blockingPropranolol also shows some class I action

Class Known as Examples Mechanism

β blockers

Anti arrhythmic Drugs Class III Drugs ( K+ Channel blockers )

IIIAgents

widening AP(K+ Channel

blockers)

Amiodarone Ibutilide Dofetilide Dronedarone

K+ channel blocker Sotalol is also a beta blocker Amiodarone has Class I, II, III

& IV activity

Class Known as Examples Mechanism

Anti arrhythmic Drugs Class IV Drugs ( Calcium channel blockers )

IVCalcium channel blockers

Verapamil Diltiazem Ca2+ channel blocker

Class Known as Examples Mechanism

Calcium channel blockers

THANK YOU……