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We report the first two documented cases of the deliberate metoprolol overdose occurring in the United States, one of which eventually proved fatal. The potentially lethal cardiotoxic effects of this drug are illustrated and correlated with the blood and tissue levels of metoprolol. We emphasize the often sudden and rapid clinical deterioration which excessive ingestion of this drug may produce, and the need for close, careful supervision and monitoring of these patients.

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A 26-year-old woman was hospitalized with new-onset congestive heart failure. M-mode and two-dimensional echocardiography revealed abnormal motion involving the apex and posterolateral wall of the left ventricle. Cardiac catheterization was performed. The left ventriculogram demonstrated apical akinesis and an apical filling defect. The diagnosis of cardiac sarcoidosis was made from an open myocardial biopsy.

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