General therapeutic principles
In the treatment of cardiac dysrhythmia, causal therapy is the first priority. If the cardiac dysrhythmia is caused by cardiac diseases or metabolic disorders (e.g. hyperthyroidism), the first step is to treat them. Often the cardiac dysrhythmia then recedes. If it is not possible to treat the underlying disease of the cardiac arrhythmias (e.g. if a heart attack has caused permanent damage to the heart muscle) or if the cardiac arrhythmias persist despite treatment of the underlying disease, symptomatic therapy (treatment of the symptoms) is applied. In symptomatic therapy of cardiac arrhythmias, a distinction is made between general measures such as sedation, oxygenation and possibly bed rest and direct antiarrhythmic therapy, which rests on three pillars:
- Drug therapy
- Electrotherapy e.g. cardiac pacemaker
- Heart Surgery
Drug therapy with antiarrhythmics
Drugs used to treat cardiac arrhythmias often have very complex effects on, among other things, the excitability of the heart, the heart rate and other electrophysiological properties of the heart. It must be decided individually for each patient which drug is the most suitable for his or her condition. The following list therefore provides an overview of the individual classes of antiarrhythmic drugs according to Vaughan WILLIAMS and also lists the main indications, i.e. areas of use without going into further detail about the individual effects and side effects, so as not to confuse the reader.
a) Quinidine, Ajmalinb) Lidocainc) propafenone Field of application: mostly used in acute ventricular arrhythmias. The problem with class I antiarrhythmics is that under certain conditions they can lead to rhythm disturbances, although they are used against them. They should therefore only be used after a careful risk-benefit analysis. e.g. bisoprolol, metoprolol Use: tachycardias, condition after myocardial infarction In addition to the direct treatment of cardiac arrhythmias, beta-blockers are also used to treat the underlying diseases that lead to arrhythmias, such as coronary artery disease (CHD), e.g. amidarone or sotalol Use: ventricular arrhythmias and atrial fibrillation Use: atrial fibrillation
