Beta blockers for congestive heart failure.

The prognosis remains poor for many patients with congestive heart failure, despite maximal medical treatment with ACE inhibitor, diuretics and digitalis. In heart failure, activation of sympathetic nervous system has been described as one of the most important pathophysiologic abnormalities in patients with congestive heart failure and as one of the most important mechanisms that may be responsible for progression of heart failure. The use of beta blockers which may inhibit sympathetic activity, might reduce the risk of disease progression in heart failure, improve symptoms and increase survival. Several large clinical trials with metoprolol, carvedilol and bisoprolol have shown that long term use of these agents can improve left ventricular function and symptoms of CHF, it may also reduce hospital readmission and decrease mortality. Current guidelines recommend the use of beta blocker in mild, moderate and severe CHF, in the absence of contraindications or tolerance in combination with ACE inhibitor and diuretics. Beta blocker should be initiated in patients after maximal medical therapy with diuretics, ACE inhibitor and digitalis and patients already stabilized and in compensated conditions. Beta blocker should be started in low doses and require slow titration over weeks or months before patients can attain maintenance doses.

Wolf-parkinson-white syndrome presented with broad QRS complex tachycardia.

Broad QRS complex tachycardia is tachycardia with widened QRS complex more than 12 s and caused by various mechanisms, either supraventricular or ventricular. It is important to differentiate between ventricular and supraventricular because it will determine treatment and prognosis of patients. We report a case which was referred to us and first diagnosed as ventricular tachycardia but happened to be atrial fibrillation with RBBB. On ECG examination we found irregular broad complex of tachycardia, RBBB, extreme right axis and heart rate 170-180 beat/minute. Intravenous bolus of 300 mg amiodarone was administered within 30 minutes and continued with 900 mg/24 hours. During administration of amiodarone, heart rhythm was converted to sinus rhythm with short PR interval (0.09 s), left axis deviation, and positive delta wave at lead V1. The final diagnosis of wolf-parkinson-white (WPW) syndrome was then confirmed.

Lipid profiles of acute coronary syndrome patients hospitalized in ICCU of Cipto Mangunkusumo Hospital.

AIM: to see which component of the triad lipid that has more important role and frequently found in patients with acute coronary syndrome, focusing on HDL cholesterol. METHODS: a lipid profile study has been conducted in 391 patients with acute coronary syndrome (ACS), who have been hospitalized in ICCU of Cipto Mangunkusumo Hospital since January 1st, 2001 - December 31st, 2005. RESULTS: there were 294 male patients (75.2%) and 97 female patients (24.8%), from 25-89 years age group, with mean value 57.35 +/- 11.05. The mean value of total cholesterol level was 205.23 mg/dl +/- 54.84. The LDL cholesterol level was 136.16 mg/dl +/- 47.29. The mean HDL cholesterol level was 42.84 mg/dl +/- 10.28, mean triglycerides level was 157.25 mg/dl +/- 100.16. There were 82 patients (21%) with high total cholesterol (> 240 mg/dl), 102 patients (26.1%) with high and very high LDL cholesterol level (> 160 mg/dl), 152 (38.6%) patients with low HDL cholesterol level (< 40 mg/dl), consisted of 126 male patients or 42.9% of total male patients, 26 female patients or 26.8% of total female patients. The number of patients with high / very high triglycerides level (> 200 mg/dl or 500 mg/dl) was 84 patients (21.5%). The number of patients with optimal lipid level, total cholesterol level < 200 mg/dl was 191 patients (48.8%); 82 patients (21%) had LDL cholesterol level < 100 mg/dl, 23 patients (5.9%) had HDL cholesterol level > 60 mg/dl, 226 patients (57.8%) had triglycerides level < 150 mg/dl. There were 260 patients with atherogenic lipid profile (64%), 135 patients with borderline lipid profile (34.5%), and optimal lipid profile was found only in 6 patients (1,5%). The mean value of HDL cholesterol level in male patients was 41.75 mg/dl +/- 9.9, while HDL cholesterol level in female patients was 46.16 mg/dl +/- 10.74. Principally, lipid profiles of all age groups were evenly distributed. ACS patients with history of family heart disease had a more atherogenic lipid profile compared to lipid profile of patients with hypertension, diabetes mellitus, and cigarette smoking. CONCLUSION: atherogenic lipid profile is more common risk factor in ACS patients than in other non-lipid risk factors. This study also demonstrated that the atherogenic lipid is most commonly found in patient with low HDL cholesterol level and it is least frequently found in patient with optimal lipid profile.