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A chest X-ray demonstrating pulmonary fibrosis due to amiodarone. Side effects of oral amiodarone at doses of 400 mg or higher include various pulmonary effects. [44] The most serious reaction is interstitial lung disease. Risk factors include high cumulative dose, more than 400 milligrams per day, duration over two months, increased age, and ...
Amiodarone is also safe to use in individuals with cardiomyopathy and atrial fibrillation, to maintain normal sinus rhythm. Amiodarone prolongation of the action potential is uniform over a wide range of heart rates, so this drug does not have reverse use-dependent action. Amiodarone was the first agent described in this class. [4]
Budiodarone (ATI-2042) is an antiarrhythmic agent and chemical analog of amiodarone that is currently being studied in clinical trials.Amiodarone is considered the most effective antiarrhythmic drug available, [1] [2] [3] but its adverse side effects, including hepatic, pulmonary and thyroid toxicity as well as multiple drug interactions, [4] are discouraging its use.
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). [1] [2] A defibrillator delivers a dose of electric current (often called a counter-shock) to the heart.
Since these agents do not affect the sodium channel, conduction velocity is not decreased. The prolongation of the action potential duration and refractory period, combined with the maintenance of normal conduction velocity, prevent re-entrant arrhythmias. (The re-entrant rhythm is less likely to interact with tissue that has become refractory).
Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period (or relative refractory period) of the cardiac cycle, which could induce ventricular fibrillation. If the patient is conscious, various drugs are often used to help sedate the patient and make the procedure more tolerable.
Amiodarone may be used in cases of ventricular fibrillation, pulseless ventricular tachycardia, and wide complex tachycardia. [110] Lidocaine is a class Ib anti-arrhythmic, also used to manage acute arrhythmias. [111] Anti-arrhythmic medications may be used after an unsuccessful defibrillation attempt.
The definition of refractory shock or vasodilatory shock varies. In 2018, the American College of Chest Physician stated that it is presents if there is an inadequate response to high-dose vasopressor therapy defined as ≥ 0.5 mg/kg/min norepinephrine-equivalent dose. [4]
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