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Antiarrhythmics (Lesson 5 - Calcium Channel Blockers)

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An overview of the mechanism, indications, and side effects of calcium channel blockers.
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Text Comments (9)
Strong Medicine (1 year ago)
I'm sorry, an unanticipated work issue prevented me from finishing te series before heading to a conference, followed by vacation. The last 2 videos will be posted in about 2 weeks.
Strong Medicine (1 year ago)
My favorite channels that are in the same genre as mine are Osmosis (gives ~10 min introductions to a wide variety of clinical disorders - great for preclerkship med students going through their pathology and pathophysiology courses), The Noted Anatomist (covers anatomy only, but has fantastic diagrams and explanations), and Armando Hasudungan (10-15 min videos on a variety of basic and clinical science, draws pictures and diagram in pseudo-real time with voiceover narration).  And 2 channels which are great specifically for the physical exam are Stanford Medicine 25 and Geeky Medics.  Links to all of them are on the right of the screen off my main channel page.
chughi (1 year ago)
Strong Medicine I enjoy your videos, I was wondering if you could recommend other channels that are similar to yours or that you find interesting or educational, thanks.
imene imaya (3 months ago)
very helpful serie thank you so much
Md.Mojammel Hoque Mohim (6 months ago)
Dear sir, thanks a lot for these great vedios. I have very little problem with this vedio. You told that ' Diltiazem and Verapamil are used to terminate and prevent AVNRT and AVRT'. But it has been written in book that Verapamil shouldn't be used in AVRT. Source:- Davidson's Principles and Practice of Medicine, 22nd Edition, 569 page. I am just confused. Would you mind to make it clear to me. Thank you so much sir again.
Md.Mojammel Hoque Mohim (6 months ago)
Thank you sir. I am just a med student yet. It's really tough to understand for me details of the electrophysiology of the drugs. Anyway, I was just going through my medicine book after watching your vedios. I got this problem. Thank you so much again. Hopefully I will understand those complicated topics clearly with the help your your great works.
Strong Medicine (6 months ago)
Thanks for the great question! This is a nuanced point typically reserved for the realm of electrophysiologists. Taken from ACC/AHA 2015 joint guidelines for management of SVTs (http://www.onlinejacc.org/content/67/13/e27/T11): "Class I indication/LOE C: Oral beta blockers, diltiazem, or verapamil are indicated for ongoing management of AVRT in patients without pre-excitation on their resting ECG. Observational studies and clinical experience confirm that beta blockers, diltiazem, and verapamil are effective for preventing recurrent tachycardia in approximately 50% of patients without pre-excitation on their resting ECG (concealed accessory pathway) and are associated with a favorable side effect profile... Class IIb indication/LOE C: Oral beta blockers, diltiazem, or verapamil may be reasonable for ongoing management of orthodromic AVRT in patients with pre-excitation on their resting ECG who are not candidates for, or prefer not to undergo, catheter ablation. One RCT supports the use of verapamil for prevention of orthodromic AVRT in patients with pre-excitation on their resting ECG (manifest accessory pathway). There are no RCTs supporting the use of oral beta blockers or diltiazem for prevention of recurrent AVRT, although clinical experience suggests the drugs are effective, with a favorable side effect profile. Patients with pre-excitation may develop AF during an episode of AVRT and be exposed to increased risk of rapid conduction over the accessory pathway while receiving beta blockers, diltiazem or verapamil, so these agents must be used with caution. The decision to treat with these agents should follow a discussion of risks with the patient. Although evidence of poor anterograde conduction via the accessory pathway may be reassuring, rapid conduction in AF has been described even in the setting of intermittent anterograde conduction." So the short answer is that beta blockers, diltiazem and verapamil can be used to either rate control a-fib/a-flutter, or for management of orthodromic AVRT, but are best avoided in most patients who are affected by both rhythms. And none of these drugs would ever be your first choice to manage AVRT, as the first line treatment for nearly all patients is catheter ablation of the accessory pathway.
Steven Svoboda (9 months ago)
if calcium channel blockers and sodium channel blockers (class 1a) both decrease the upstroke, why is it that CCBs only cause prolonged action potential and class 1a sodium channel blockers don't?
nijijic (1 year ago)
Thank you for prompt updating this series, help a lot!

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