Convert this page into simple and concise notes with meaningful line. Only include important lines
cd /home/daytona/workspace/attachments/35afd431-65df-4172-b09d-8ad754985393/ && convert 20260507_203453.heic output_page.jpg 2>&1 && echo "Done"
python3 -c " from PIL import Image img = Image.open('/home/daytona/workspace/attachments/35afd431-65df-4172-b09d-8ad754985393/20260507_203453.heic') img.save('/home/daytona/workspace/attachments/35afd431-65df-4172-b09d-8ad754985393/output_page.jpg', 'JPEG') print('Saved') " 2>&1
pip install --user pillow-heif 2>&1 | tail -3
python3 -c " import pillow_heif from PIL import Image pillow_heif.register_heif_opener() img = Image.open('/home/daytona/workspace/attachments/35afd431-65df-4172-b09d-8ad754985393/20260507_203453.heic') img.save('/home/daytona/workspace/attachments/35afd431-65df-4172-b09d-8ad754985393/output_page.jpg', 'JPEG', quality=95) print('Saved, size:', img.size) " 2>&1
python3 -c " import pillow_heif from PIL import Image pillow_heif.register_heif_opener() img = Image.open('/home/daytona/workspace/attachments/35afd431-65df-4172-b09d-8ad754985393/20260507_203453.heic') img_small = img.resize((1000, 1333)) img_small.save('/home/daytona/workspace/attachments/35afd431-65df-4172-b09d-8ad754985393/output_small.jpg', 'JPEG', quality=85) print('Saved small') " 2>&1 # Also run OCR python3 -c " import pytesseract from PIL import Image img = Image.open('/home/daytona/workspace/attachments/35afd431-65df-4172-b09d-8ad754985393/output_page.jpg') text = pytesseract.image_to_string(img) print(text) " 2>&1
Chapter 38 — Antiarrhythmic Drugs
- ~3 out of 4 MI patients show some cardiac rhythm irregularity.
- ~half of patients given general anaesthesia show rhythm irregularity.
- Arrhythmias are the most important cause of sudden cardiac death.
- Only a few arrhythmias actually need antiarrhythmic drug treatment.
Important Mechanisms of Cardiac Arrhythmias
- Phase-4 depolarization slope increases → automatic fibres fire abnormally.
- Ischaemia partially depolarizes myocardial cells → injury current between these and normal fibres → initiates an impulse.
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EAD (Early After-Depolarization): Phase-3 repolarization is interrupted; membrane potential oscillates. If large enough, propagates extra impulses.
- Associated with long Q-T interval, slow heart rate.
- Caused by depression of delayed rectifier K⁺ current.
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DAD (Delayed After-Depolarization): After reaching RMP, a secondary deflection occurs in phase 4; may reach threshold and fire a premature AP.
- More common at fast heart rate.
- Caused by Ca²⁺ overload (e.g., digitalis toxicity, ischaemia-reperfusion).
- Arrhythmias from after-depolarizations = triggered arrhythmias.
- Impulse recirculates in the heart, causing repetitive activation without a new impulse → reentrant arrhythmias.
- Circus movement reentry: Premature impulse blocked in one direction by refractory tissue → travels one-way around an obstacle (A-V node, abnormal tract) → finds the original site recovered → reexcites it, setting up a loop.