choosing the appropriate anti-arrhythmic drug distinguishes the smart cardiologist. Also, expecting the most common side effects help you treat downs.
Hello my dear doctors welcome at dr ramy cardio club today i would like to discuss with you a very interesting case here we go we have 40 years old gentleman came to the er complaining of dizziness diaphoresis and palpitation his blood pressure is 100 over 60 heart rate is around 160 beats per minute his ecg is sean pilot how interesting what is your next step
To treat him look at this ecg look at this what do you see yeah just keep it in your mind how about the answers given your next step is enter a venus amiodarone intravenous adenosine oh my god i would like to see the ecg again okay it’s now clear we have wide complex tachycardia this is how i usually describe what i say in the ecg i say tachycardia it is
White complex tachycardia and it is irregular okay so what is your next step yes it is the correct answer here is not cardioversion okay so what is the next step what is the answer the answer is intravenous propafinon intravenous propafinone this is what i’m going to talk about in this session intravenous propafenone our patient has pre-excited atrial
Fibrillation wolf perkins and white syndrome as you see here how this ecg was developed it has been developed because the patient has an accessory pathway connection between the edge and ventricle it is green in color in this diagram this is a fast accessory pathway so a premature pace develops in the atria will cross the accessory pathway not the av node which
Is the physiologic pathway and then it goes again to the to it will pass from the ether to the ventricle through the accessory pathway and then go again to the atria through the every node and then it will pass again through the accessory pathway then a vicious circle will happen and the arrhythmia will be developed okay this is how arrhythmia like this is
Developed so it is atrial fibrillation developed by presence of an accessory pathway so we call it pre-excited af wolf parkinson white syndrome so why cardioversion is not the correct answer let’s discard the answers given to us intravenous amiodarone amidaron for a long time was described as the drug of a choice but in the recent guidelines because amiron
Has been recognized that it has a beta blocking effect it will not reasonable here because we will skip giving a beta blocker or any kind of heavy node blocker in this situation because if you give an ev node blocker here you will encourage peace to be going through the accessory pathway which is very fast conducting pathway so i will have a more aggressive
Arrhythmia and an increase in the heart rate so beta blocking effect is better to be avoided here so intravenous amide run will not be the answer here cardioversion will be the answer of a choice if the patient is vitally unstable our patient has a blood pressure 100 over 60. it is a little low but he is still vitally stable so cardioversion is reserved for
Patients who are vitally unstable intravenously la petite elizabeth blocker it is not the answer definitely propafinon propriphenone is a class 1c antiarrhythmic drug which is working on inhibiting the conduction through the accessory pathway so it will be the drug of a choice also intravenous verapamil vrapamel is a calcium channel blocker and encourage the av
Node blocking and the delay of conduction so it is resembling lapita load it is not the answer digoxin is not the answer here because it is carrying and if you’re not blocking effect encouraging the vagal stimulation to the even odd slowing the conduction through the heavy node it is not it will not be the answer intravenous adenosine it is an ev node blocker very
Fast which is reserved for supraventricular tachycardias not this kind of arrhythmia so the question now is let’s talk shortly about antiarrhythmic drugs and then to the drug of choice here which is proper phenomenon what we know and what we don’t know to summarize antiarrhythmic medications in a very simple way it is classified as class 1 class 2 class 3 class
4 and miscellaneous group class 1 they are sodium channel pluckers it includes the class 1a canadian this is very old class 1p lidocaine and class 1c which is the most recent one which is used for many of arrhythmias supraventricular and ventricular sometimes includes flaccinite and propafenone propafenon is a drug of choice here class ii antiarrhythmic drugs
Are pita blockers the piece of product prolol and so on class three is potassium etchant blockers amiodarone druniderone sutyalol dophiti lead and epithelid the class 3 the class 3 has a very famous side effect which is the prolonged qt interval in the ecg causing more liability for developing ventricular tachycardia so you have to watch them carefully
The difference between amiodarone and the drunidarone amiodarone has 30 percent iodine 30 percent of its weight is iodine but gironidaron is not so amidarone will be affecting your thyroid gland but reunite is not class four antiarrhythmic drugs calcium cha blocker the the group that is non-dihydropyridine groups which are working on the myocardium inhibiting
The myocardial contractility and inhibiting conduction through the av nodes slowing the heart rate they are verapamil and delties miscellaneous group adenosine which is very fast very fast heavy note blocker used for supraventricular tachycardia digoxin is another member magnesium sulfate digoxin is used mainly for atrial fibrillation atrial fibrillation but
Not this one not the pre-excited one okay magnesium sulfate magnesium sulfate is a drug used to slow the conduction through the av node used also in medicine as a bronchodilator in bronchial asthma patients and it is also used in the pre-clamps and eclampsia as a vasodilator lowering down the blood pressure of a pregnant lady right how about proper
Phenomena proper phenomenon is class 1c antiarrhythmic drug it is used for most the supraventricular tachycardias includes atrial fibrillation and flutter actually we use it as a pier in the pocket fashion which means that we educate our patients that when they have an attack of atrial fibrillation if it is perceptible one when you have it and you feel it and you
Feel it is a regular piece you can take the propa phenom and repeat it over the day for a couple of days until the the heart rhythm is going back to sinus rhythm and regular one okay constipation is the most common side effect of propafenone actually verapamil and deltazine also calcium sharp blockers are carrying the same side effect other side effects include
Bradycardia they slow down the heart rate not powerfully but they actually does arrhythmias any antiarrhythmic drug be sure that it will cause another arrhythmia chest pains and dizziness are very common propafino needs a structural and functional normal heart you cannot give it to any patient with a structural or functional abnormality because so easily you
Can have an aggressive kind of rhythm you may use propafenone to trade supraventricular taker card but actually if you give it to structurally or functionally abnormal heart it may cause ventricular tachycardia which is very aggressive and you may lose your patience another very interesting thing about propafinon is that it follows slow kinetics what does it
Mean it is a pharmacological term describes that the drug will be causing its effect its maximum effect its maximum work gonna get the maximum of the drug if the heart rate is slow so actually i noticed in my practice that when i combine this kind of medication class 1c antiarrhythmic drug with a beta blocker it causes a more control of the heart rhythm they
Are used mainly to get your rhythm back to sinus rhythm back to regular one so it’s it gives its maximum effect as an antiarrhythmic going back to the sinus rhythm if your heart rate is slow if they are not able to slow it down because it’s very fast you can combine with them a beta blocker calcium channel blocker so you get a better response to the treatment
With propafenone or flakkinite my beloved doctors i wish you found this session um interesting to you i wish you the best of luck i see you again and again in more videos bye bye
Transcribed from video
what we know and what we don't know about anti-arrhythmics; propafenone. By Dr. Ramy Cardio Club
