Cardiac Activity Heart rate variability

Gilliam FR, Kaplan AJ, Black J, Chase KJ, Mullin CM. Changes in Heart Rate Variability, quality of fife, and activity in cardiac resynchronization therapy Results of the HF-HRV Registry. Pacing Clin Electrophysiol 2007 30 56-64. 

The QT interval is a dynamic physiological variable depending on multiple factors such as cardiac cycle length (heart rate), autonomic nervous system activity, age, gender, plasma electrolyte concentrations, genetic variations in ion channels involved in cardiac repolarization. In addition, circadian and seasonal variations of the QT interval have been described [93]. 

The basic pharmacological action of Ephedrine is that of a sympathomimetic. It does not contain a catechol moiety and is effective after oral administration. The drug stimulates heart rate and cardiac output and variably increases peripheral resistance as a result, ephedrine usually increases blood pressure. Stimulation of the a-adrenergic receptors of smooth muscle cells in the bladder base may increase resistance to the outflow of urine. Activation of S-adrenergic receptors in the lungs promotes bronchodilation. Ephedrine stimulates the cerebral cortex and subcortical centers to produce its effects in narcolepsy and depressive states. 

These animal studies should indicate to the pharmacist that blood flow can, under certain circumstances, be an important patient variable that may affect the absorption of drugs. Patients in heart failure would generally be expected to have a decreased cardiac output and, therefore, a decreased splanchnic blood flow. This could lead to a decreased rate of absorption for drugs when the blood flow rates in Eq. (7) become rate-limiting. In addition, redistribution of cardiac output during cardiac failure may lead to splanchnic vasoconstriction in patients [57], Other disease states and physical activity can also decrease blood flow to the GIT [2 4], Thus, the pharmacist must be aware of the possible effect of blood flow rate, especially alterations in the rate, on the availability of drugs. 

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