ABSTRACT
We present a case of massive pulmonary embolism where the electrocardiogram (ECG) demonstrated transient T-wave inversion and marked QT-prolongation. The pathomechanism and clinical significance of these changes are discussed.
Subject(s)
Heart Conduction System/physiopathology , Tachycardia, Ventricular/physiopathology , Action Potentials , Adult , Anti-Arrhythmia Agents/therapeutic use , Cardiomyopathies/complications , Electrocardiography , Electrophysiologic Techniques, Cardiac , Female , Heart Conduction System/drug effects , Humans , Sarcoidosis/complications , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/drug therapy , Tachycardia, Ventricular/etiology , Time FactorsABSTRACT
BACKGROUND: A beneficial effect on survival has been proven for the four long-acting beta-blockers. Such favorable results could not be obtained with short-acting beta-blockers. AIMS: to study the safety of switching from short-acting metoprolol to long-acting bisoprolol in patients with cardiac failure and postinfarction impaired left ventricular systolic function. METHODS AND RESULTS: 282 patients with NYHA classes I-III heart failure and/or postinfarction reduced left ventricular ejection fraction were enrolled in the study. Metoprolol tartarate was discontinued 12 h before the initiation of bisoprolol therapy. Dosages were as follows: 28.5% of the patients reached the 10 mg target dose, 21.5% received 7.5 mg, and 42.5% received 5 mg, while 7.5% stayed on the lowest 2.5 mg initial dose. Mean heart rate was 84 bpm before the switch; this dropped to 67 bpm with the above doses. CONCLUSION: The switch from non-recommended short-acting beta-blockers to long-acting beta-blockers may be carried out safely in stable heart failure patients. The significant reduction of the heart rate indicated that a more effective adrenergic blockage might be obtained with the switch, although physicians could titrate up to the target dose only in about one-third of the cases.
Subject(s)
Adrenergic beta-Antagonists/administration & dosage , Bisoprolol/administration & dosage , Heart Failure/drug therapy , Metoprolol/administration & dosage , Chronic Disease , HumansABSTRACT
Here we report a case of an elderly woman whose antihypertensive beta-blocker therapy induced sinus arrest with a 40 bpm junctional escape rhythm. Although there was no sign of heart failure during bradycardia, a highly elevated amino-terminal pro-brain natriuretic peptide (NT-proBNP) serum level was detected. Cessation of the beta-blocker agent resulted in normal sinus rhythm and a rapid fall in the NT-proBNP serum level. As a rare phenomenon, bradycardia-related cardiomyopathy is discussed.
