Heart cholinergic drug effects

Drugs used for treating arrhythmia can have an effect on the electrical conduction system of the heart, its excitability, automatism, the size of the effective refractory period, and adrenergic and cholinergic heart innervation. Accordingly, compounds of various chemical classes can restore heart rate disturbances. 

Cardiovascular effects Drugs that increase cholinergic activity may have vagotonic effects on heart rates (eg, bradycardia). The potential for this action may be particularly important in patients with sick sinus syndrome or other supraventricular cardiac conduction conditions. 

ANG II is also known to induce release of catecholamines from the adrenal medulla and to suppress the reflex inhibition of the heart rate, with the latter probably the inhibiting vagal (cholinergic) neurons to the heart. This has a specific clinical effect that is useful in the use of ACE inhibitors as antihypertensives (see later) namely, the absence of reflex tachycardia seen with other types of blood pressure-lowering drugs such as a-blockers, diazoxide, hydralazine, and ganglionic blockers. 

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