automaticity – n. 自动节律性
conductivity – n. 传导性
proarrhythmic – a. 致心律失常的
hemodynamic – n. 血流动力学
CAST -- Cardiac Arrhythmia Suppression Trial
CAST – 心律失常抑制试验
reflex arrhythmias – 反射性节律异常
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Antiarrhythmic Agents
抗心律不齐药
Antiarrhythmics affect the action potential of the cardiac cells by altering their automaticity, conductivity, or both. Because of this effect, antiarrhythmic drugs can also produce new arrhythmias—that is, they are proarrhythmic. Antiarrhythmics are used in emergency situations when the hemodynamics arising from the patient’s arrhythmia are severe and could potentially be fatal.
Antiarrhythmics were widely used on a long-term basis to suppress any abnormal arrhythmia, until the publication of the Cardiac Arrhythmia Suppression Trial (CAST) in the early 1990s. This multicenter, randomized, long-term study conducted by the National Heart, Lung, and Blood Institute looked at the mortality rate of patients with asymptomatic, non–life-threatening arrhythmias being treated with antiarrhythmics. The results showed that long-term use of some antiarrhythmics was associated with an increased risk of death. In fact, the risk of death for some patients was two to three times greater than that for untreated patients. These results prompted more clinical trials to look at the effectiveness of long-term use of antiarrhythmics.
It was found that antiarrhythmics may block some reflex arrhythmias that help to keep the cardiovascular system in balance, or they may precipitate new, deadly arrhythmias. Therefore, it is important to document the arrhythmia being treated and the rationale for treatment and to monitor a patient regularly when using these drugs.
1. Conduction defects will most likely be an adverse associated with the use of:
A. Verapamil (Isoptin)
B. Nifedipine (Adalat CC)
C. Diltiazem (Cardizem)
D. Felodipine (Plendil) 2. Jason James is taking ß blockers, all of the following should be included in his assessment except:
A. Pulmonary function tests.
B. Baseline ECG.
C. Glucose level.
D. Blood pressure.
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答案Answer 1. A. Verapamil (Isoptin). Rationale: Verapamil (Isoptin) has the strongest chronotropic effect and will cause a delay in conduction at the SA and AV nodes. Verapamil also increases myocardial oxygen delivery, which helps patients with vasospastic angina. Verapamil correlates with negative chronotropic effects and a decrease in sympathetic nervous system activity. 2. A. Pulmonary function tests. Rationale: Unless the client has a history of pulmonary disease and pulmonary function tests are indicated, there is no need to include this in the routine assessment of the client taking ß blockers. Beta-blockers, as a class of drugs, are primarily used to treat cardiovascular diseases and other conditions.
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