1. 1 Chapter 6 Drugs for Cardiovascular Arrhythmias and Hypertension

2. 2  Hank Gathers  hypertrophic cardiomyopathy  Flo Hyman  Marfan’s syndrome  Jim Fixx  atherosclerotic coronary artery disease  Darryl Kile  atherosclerotic coronary artery disease

3. 3  “Pistol” Pete Maravich  abnormal coronary arteries  Len Bias  illegal drugs  High School versus College Athlete  Changing cardiovascular development

4. 4 Arrhythmias  “Irregular heart action caused by physiological or pathological disturbances in the discharge of cardiac impulses from the sinoatrial node or their transmission through conductive tissue of the heart.”

5. 5 Arrhythmias  Medications control arrhythmias and assist the heart in maintaining a normal rhythm  Device-based techniques  Implantable pacemakers or defibrillators  Can result in syncope, fatal in certain sports  Table 6-1, pg 82

6. 6 Arrhythmias  Common Forms of Arrhythmias  Table 6-2,pg 83

7. 7 Arrhythmia Medications  Four subclassifications  Class ISodium channel blockers  Class IIβ-adrenergic blockers  Class IIIPotassium channel blockers  Class IVCalcium channel blockers

8. 8 Adverse Effects  Lethargy  Fatigue  Bradycardia  Orthostatic hypotension  Cold extremities  Rashes, pruritus, headache, nausea, diarrhea, swelling, behavioral disturbances, disorientation

9. 9 Adverse Effects (cont.)  Despite the purpose of reducing arrhythmias one of the most common side effects of the anti arrhythmic drugs is the increase in rhythm disturbances.

10. 10 Antiarrhythmic Drug Interactions  Table 6-3, pg 85

11. 11 Device Therapy  Pacemakers – first implanted (1958)  Implantable cardioverter defibrillators (ICD) – (1980)  Not common in athletes

12. 12 Hypertension  Hypertension is the “pressure in the pipes”  Diet, stress, genetics, etc.  Approximately 24% of population  Females have higher rates  BP > 140 mm Hg  on three separate occasions  Essential hypertension  No known cause  Secondary hypertension  Diagnosable cause

13. 13 BP Classifications  Normal<120/<80  Prehypertension120 –139/80–89  Hypertension  Stage 1140 – 159/90 – 99  Stage 2>160/>100  Stage 3 Physician’s care

14. 14 Monitor variables that can affect BP  Salt and intake of high-sodium and high- fat foods (PJ)  Alcohol  Over-the-counter stimulants - caffeine/cold medication  Diet pills  Smoking or chewing tobacco  Cocaine or anabolic steroids

15. 15 Medications for Hypertension  Diuretics  Calcium channel blockers  ACE Inhibitors  Angiotensin II blockers  Beta blockers  Alpha-blockers

16. 16 Adverse Effects  Diuretics  Orthostatic hypotension  Dehydration – electrolyte imbalance  ACE inhibitors  Cough  Beta blockers  Bradycardia, fatigue, dizziness  Alpha-blockers  Tachycardia/orthostatic hypotension

17. 17 Hypertension in the Athlete/Active Population  Table 6-6, pg 88

18. 18 What to Tell the Athlete  Page 88