Heart rhythm disorders or

arrhythmias are frequent complications of

myocardial infarction. Arrhythmia or
dysrhythmias are changes in heart
frequency and rhythm caused by
abnormal or automatic conduction of
electrolytes.
Arrhythmia occurs because
electrical impulses that work the
heartbeat do not function properly
 In patients diagnosed with arrhythmia
it will feel:
   Heart beating fast
   Suddenly the heart beats more
   Beat too fast (tachycardia) or too

slow (bradycardia)
   Don't feel anything, because

arrhythmia can asymptomatic

(without symptoms)
 The most common types of arrhythmias
are:
 Bradycardia: The heart beats slower or
irregularly
 Heart block: The heart beats slower and can
cause a person to faint
 Supraventricular tachycardia: The heart
beats abnormally fast
 Atrial fibrillation: The heart beats very fast,
even while resting
 Ventricular fibrillation: Causes sufferers to
lose consciousness or sudden death due to
heartbeat that is too fast and irregular
 classification of anti-arrhythmic
drugs
 Class I (a, b, & c): Sodium channel
blockers
 Class II: Beta Adrenergic Blockade
 Class III: Repolarization inhibitors
 Class IV: Calcium antagonist
 Class I : Sodium channel blockers
 I : Inhibits fast sodium ion channel type,
decreases ventricular conduction, can inhibit
ventricular ectopy activity to prevent PVC.

 IA : reduce the speed of depolarization,

extend the duration of the action potential.
Slows jabtung conduction, extending the
refractory period

 Examples of drugs: quinidine, procainamide,

disopyramide
Quinidine
The mechanism of action of
the drug:
 This drug works by

blocking irregular
heartbeat signal flow and
increasing the heart's
ability to work normally.
 In certain cases, quinidine

can also be used to treat

malaria by stopping the
development of parasites
in the body.
 MECHANISM: blocking irregular heartbeat signal flow
and increasing the heart's ability to work normally.
 INDICATION: Dosage for oral administration (tablets)
 DOSE:
• Premature atrial and ventricular contractions Adults: 200-300
mg 3-4 times a day.
• Atrial fibrillation Adult: 200 mg every 2-3 hours or 5-8 times a
day. Doses can be increased up to 3-4 g / day. For maintenance
doses can be consumed 200-300 mg 3-4 times a day.
• Supraventricular tachycardia Adult: 400-600 mg every 2-3
hours per day until normal rhythm.
• Falciparum malaria: Adults and children: 300-600 mg, or 10 mg
/ kg body weight every 8 hours for 5-7 days.
 TOXICITY
• Stomach aches to cramps.
• Gastric pains
• Dizzy
• Easy to feel tired and weak
• Blurred or double vision
• Tremor
• A rash appears on the skin
 IB: reducing the rate of depolarization
selectively in ischemic cells,
shortening the duration of potential
action, can slightly shorten the
refractory period.

 Examples of drugs : lignocaine,

mexiletine
IB(LIDOCAINE)
 MECHANISM: how to inhibit the signals that cause pain
so as to prevent pain. Lidocaine is not a general
anesthetic, so the numb effect caused is not
accompanied by loss of consciousness
 INDICATION: Relieve pain in the body temporarily and
overcome disorders of the heart rhythm
 DOSE:
• Injections (emergency) Adult: 300 mg given through the
shoulder muscles. Can be repeated after 60-90 minutes, if
needed.
• Injectable (stable) Adult: 1-1.5 mg / kg, can be repeated if
needed. Maximum dose: 3 mg / kg body weight. Can be
repeated once or twice. The dosage needs to be reduced if the
use of the drug is longer
 TOXICITY
• Hypotension
• Swelling due to fluid buildup
• Nausea and vomiting
• Fever
• Dizzy
• Tremor
• Headache
 IC: significantly reduces the rate of
depolarization, significantly reduces
cardiac conduction, slightly increases
the refractory period.

 Examples of drugs : flecainide,

propafenone
IC(PROPAFENONE)

 MECHANISM: by inhibiting the activity of

the heart's electrical signals that cause
heart rhythm disorders.
 INDICATION: Overcoming heart rhythm
disorders
 DOSAGE: To treat arrhythmias, the doctor
will give a film-coated tablet to an adult
patient with an initial dose of 150 mg, 3
times a day. Doses can be increased to 300
mg, 3 times a day, at intervals of 3-4 days
 TOXICITY:
• The body gets tired easily
• Heart beat
• Chest pain
• Heart failure
 Class II: Beta Adrenergic Blockade

 Examples of drugs: Atenol,

Metroprolol, Propanolol
II(PROPANOLOL)


MECHANISM: inhibits the action of

epinephrine or adrenaline, which is a
substance in the body that can constrict blood
vessels, increase blood pressure, and increase
heart rate.
 INDICATION: Treating various disorders
related to the heart and blood vessels
 DOSE: Adults 30-160 mg per day, which is
divided into several consumption schedules.
Children 0.25-0.5 mg / kg, 3-4 times a day.
 Class III : Repolarization inhibitors
 Inhibits the potassium canal,
reducing the rate of potassium efflux.
Preventing reentran arrhythmias both
atrial and ventricular, better in
maintaining sinus rhythm after
cardioversion from AF.

 Example of drugs: Sotalol (has b-

blocker properties), amiodarone,
Perhexiline, digoxin
 TOXICITY:
• Nausea and vomiting
• Constipation
• Diarrhea
• Stomach cramps
• Insomnia
• Impotence
 Class IV: Calcium antagonist
 Inhibiting ventricular response to AF
and preventing arrhythmias from
restoring AV nodules can also prevent
arrhythmias due to early
depolarization such as torsades
d'pointes.

 Example of drugs: Diltiazem,

verapamil
 Cardiotonics
 Cardiotonics are drugs with
properties that strengthen heart
muscle contractility (positive
ionotropic effects).

 Cardiotonics is mainly used in people

with heart failure (decompensation)
to improve the function of the pump.
 Heart failure
Heart failure is a complex clinical
syndrome due to structural and
functional abnormalities of the heart
that impairs the ability of the
ventricles to be filled with blood, or to
bleed.
As a result of this weakness of the
heart, blood is blocked in the lungs
and legs, which causes difficulty in
breathing and edema during foot
 The main goal of treatment for
heart failure is
 Reducing the burden of the heart
(resting, losing weight, eliminating
causes, inhibiting salt intake, etc.).
 Increase myocardial contractility with
compounds that have positive
inotropic effects (cardiac glycosides,
etc.).
 Pressing preload and afterload.
 Antiarrhythmics to correct the
frequency and abnormalities of the
 classification of cardiotonic drugs
 Cardiac Glycosides
 Dopaminergic
 Phosphodiesterase inhibitors
 Cardiac glycosides
All cardiac glycosides have the
effect:
1. Increase the strength of heart
muscle contraction (positive inotropic
action)
2. Slows the heart rate frequency
(negative chronotropic action)
3. Suppress excitement (negative
dramatic work)
4. Lowering the threshold value of
 Digoxin (Lanoxin)
The mechanism of action
of the drug:
Inhibits the Na-K
ATPase pump which
results in an increase in
intracellular sodium
which causes weak
sodium / potassium
exchange and increases
intracellular calcium.
 Indications:
To treat congestive heart failure, to
treat heart rhythm disturbances in the atria
(the upper porch of the heart that allows
blood to flow to the heart).

 Side effects :
Usually because high doses cause
nausea, vomiting, diarrhea, vision
problems, headaches, drowsiness,
confusion, anxiety, rhythm disorders, and
heart block.
 Dopaminergic
Dopaminergic is a central
neurotrasmitter, which as an adrenaline
precursor is an important pharmacological
property.
In peripheral tissue there are two
types of dopamine receptors:
 DA1 receptors: mainly are the smooth
muscle of the heart, brain and kidneys.
 DA2 receptor: found in the sympathetic
nerves, also in the heart and skin.
1. Dobutamine

 The mechanism of action

of the drug:
Increases cAMP
production by binding to
beta adrenergic receptors.
 Indication:
Cardiogenic shock: the
main indication of
dobutamine administration
is cardiogenic shock due to
myocardial infarction or
chronic heart failure.
 Side effects :

 Frequent: increased heart rate,

hypotension, headache, nausea,
vomiting.
 Rarely: ventricular arrhythmias (high
doses), hyperten, tissue necrosis
(due to extravasation of dopamine),
dilated pupils.
2. Dopamine

 Work mechanism :
Stimulates adrenergic
and dopaminergic receptors.
 Indications:
Cardiogenic shock in
myocardial infarction or
cardiac surgery.
 Side effects :
Nausea, vomiting,
hypertension, hypotension,
headaches, chest pain,
arrhythmias.
 Phosphodiesterase inhibitors
 Is a phosphodiesterase enzyme
inhibitor that selectively works on the
heart.

 The inhibition of this enzyme causes

an increase in cyclic AMP (cAMP)
levels in myocardial cells which will
increase intracellular calcium levels.
 1. Amrinon
 Work mechanism :
Amrinone inhibits the
isoenzyme phosphodiesterase
III, which degrades the cAMP
catalyst. This will not work on
the receptor membrane.
At the heart of the
accumulation of cAMP causes
activation of protein kinase A.
Opens calcium channels so
that more calcium ions (Ca 2
+) into the heart muscle.
Thus, the strength of heart
muscle cell contractions
increases (positive ionotropic).
 Indications:
Added to the digoxin therapy if
heart failure persists despite being
given digoxin.

 Side effects :
Gastrointestinal intolerance,
hepatotoxicity, fever, reversible
thrombocytopenia.
2. Milrinon
 Work mechanism :

The mechanism of action is the

same, but 20 times more effective
than amrinone.
 Indications:
Added to the digoxin therapy if
heart failure persists despite being
given digoxin.

 Side effects :
Headaches and worsening
angina.