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Medications for the BOTTOM of the heart



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Medications for the BOTTOM of the heart

  • The ventricular antiarrhythmic agents

Drugs used to treat abnormal rhythms from the ventricles, the bottom chambers of the heart, are called ventricular antiarrhythmic drugs. They are most often used:



    • To control distressing (and often disabling) symptoms

    • To prevent more dangerous rhythms from occurring

    • To prevent life-threatening cardiac arrest if the patient is judged to be at risk

Virtually all these drugs require careful monitoring for maximum effectiveness and the lowest possible risk of side effects. Each can be highly effective in controlling abnormal heart rhythms when chosen carefully, taken according to instructions and monitored for effectiveness. Side effects will occur in some individuals so it is important to be on the alert for them. Since side effects may occur early in use, some patients may be placed on antiarrhythmic medications in the hospital where they can be closely monitored.


Side effects range from “nuisance” discomforts that are not dangerous to more serious problems for which your doctor will invariably be vigilant.

These include:



    • Worsening of the arrhythmias already present or production of new ones (called proarrhythmia; that is, promoting rather than eliminating arrhythmia- a serious problem).

    • Causing problems with the function of other organs (lung, liver, kidney, thyroid).

    • Reducing the pumping capacity of the heart muscle (thereby worsening a “sluggish circulation” as seen in heart failure, and leading to more shortness of breath, fatigue and ankle swelling).

Just as you should report perceived side effects to your doctor for evaluation, also be sure to report the disappearance of symptoms, which the physician may consider evidence of benefit from the drug.

Remember, nothing can substitute for your doctor’s advice and information, since it will be tailored for your individual needs. Be sure to ask your doctor about important facts you should know if you are on any of these medications.
Side effects


Generic or chemical name
Side effects
Additional facts

Quinidine

Dizziness, lightheadedness, fainting, headeache, diarrhea, nausea, vomiting, belly pain, fever, ringing in the ears, rash, loss of appetite

Many known drug interactions.

More warfarin effect. More digoxin effect.

Can irate liver.

Easy bruising (low blood platelets).



Procainamide

Fever, sore throat, joint pains, rash, confusion, depression, dizziness, lightheadedness, insomnia, loss of appetite

Can reduce white blood cells, causing fever and sore throat. If these occur, notify doctor immediately.

Disopyramide

Difficulty in urination, blurred vision, dry eyes, mouth, throat, constipation, nausea, pain, bloating, gas, muscle weakness, fatigue, headache, malaise, dizziness

Can lower blood sugar producing shakiness, confusion and sweating. Can worsen “sluggish” circulation (heart failure).

Mexiletine


Nausea, vomiting, heartburn, tremor, nervousness, coordination difficulties, dizziness, lightheadedness, numbness (“pins and needles”)

Can increase action of theophylline. May rarely affect liver function tests.

Tocainide

Cough, lung irritation, rash, shortness of breath, dizziness, lightheadedness, tremulousness, coordination difficulty

Can reduce white blood cells, producing fever and sore throat. If this occurs, call doctor immediately.

Moricizine

Dizziness, nausea, upset “stomach,” vomiting, headache, shortness of breath, pain fatigue, numbness (“pins and needles”)

Shown to be of no benefit if taken shortly after a heart attack.

Flecainide

Dizziness, lightheadedness, blurred vision, “seeing spots,” shortness of breath, headache, fatigue, palpitation

Shown to be dangerous if taken shortly after a heart attack. Can worsen “sluggish” circulation (heart failure).

Propafenone

Dizziness, headache, nausea, vomiting, unusual taste, fatigue, shortness of breath, blurred vision

Can make asthma (wheezing) worse. In general, should not be used with quinidine.

Amiodarone

Cough, shortness of breath, blurred vision or “halos,” sensitivity to sunlight, rash, fatigue, malaise, tremor, poor coordination, nausea, vomiting, constipation


Can cause low or high thryroid gland activity. Can slow the heart rate excessively (especially when used with digoxin). Requires regular follow-up tests to avoid side effects.

Sotalol

Fatigue, weakness, slow heart rate (bradycardia), dizziness (low blood pressure), shortness of breath (wheezing)

In-hospital care usually required before therapy is started.


  • Combination drug treatment

Don’t be surprised if your physician places you on more than one medication to control your arrhythmia, since it may be necessary for improved effectiveness. In some cases, it may permit your physician to reduce the dosage of individual drugs, thereby reducing troublesome side effects.





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