Introduction: Our comunity has faced a challenge with the addiction to opioid, long acting medication like Methadone could be helpful in the setting of withdrawal, rehab, detox or chronic pain management, but also represent risk of dependence. Besides most of the litereatyre expose the relation between opiod could be related to cardiac disease, there is also a report relating methadone witha posible positive impact in coronary artery disease. Method: Retrospective and descriptive review of records and literature review. Result: Total of 207 of patient (pts) on methadone had coronary artery disease (CAD), of which 128 pts were known to have CAD from before, of this group the most common group was Hispanic between 45-64 years old. Regarding the cardiovascular (CV) risks, the 89.06% (114 pts) were hypertensive, 61.7% (79 pts) were diabetic, 24.21% (31pts) had Kidney disease with CKD III or more. 7% (9 pts) were known to have prolonged QTc, while 4.68% (6 pts) were newly diagnosed with it (Table 1). When we studied ejection fraction (EF), in the known CAD patients, we observed that the 20 % (26 pts) had EF < 40%, while the 10.16 % (13 pts) had intermediate EF (40-55%). Over the study period 97 pts had follow up echocardiography of with the 17.52% (17 pts) had improved EF, 64.94% (63pts) no change, while 17.52% (17 pts) had decreased EF. Regarding the cardiac events in this group, 13 patients had myocardial infarctions, of which six patients had ejection fraction below 40% and one patient had prolonged QTc (Table 2). Only 9.38% of the patients (12) had a follow up cardiac catheterization, of which 83% (10 pts) showed a progression of CAD. In the other hand, a total 38.16% (79 pts) had newly diagnosed with CAD, of which 62% (49 pts) were hypertensive, 37.97% (30 pts) had diabetes and 117.72% (14 pts) had CKD III or more. A total of 12.66% (10 pts) were known to have prolonged QTc while 6.33% (5 pts) were newly diagnosed with it. The 13.9% (11 pts) were found to have an improvement in ejection fraction while the 11.4% (9 pts) got worse. Two of these patients had myocardial infarction. (Table 3). Follow up echocardiograms showed that the ejection fraction did not get worse in 90 out of 116 patients. Overall only 1.93% (4 pts) had cardiac arrest of which 3 pts had prior history of CAD and none of them had prolonged QTc. Conclusion: This study has exposed the possibility of the positive effect of methadone in the cardiac pump function. There appears to be a progression of CAD in our patients who underwent to cardiac catheterization as a follow up, but due to the size of the sample of patient we cannot establish this relation as the definitive risk for the progression of the disease. Based on the literature review and our results, there is no doubt in the possible potential positive effect that long term use of opioids could have or maybe the negative cardiovascular effect, from the cardiac point of view. The incidence of fatal events did not represent a higher risk (Arrhythmias, myocardial infarction, or cardiac arrest) than the potential benefit (Improvement of heart function or mitigation of CAD).

Background: New advances have been made in medicine, but the incidence and prevalence of Chronic Obstructive Pulmonary Disease (COPD) are evident, and it is established as the fourth cause of death in the United States representing a high cost for the healthcare system. This condition has been related to atrial fibrillation due to the changes in the lungs and vasculature. Based on this history, we seek to evaluate the outcome of AF in the patients with COPD and its relationship with medical therapy utilized to treat this pulmonary condition with the objective of establishing the relationship between the use of beta-agonist therapy for obstructive airway disease in patients with AF. Discussion: Cell receptors participate in multiple reactions and the sympathetic response is received via the alpha- and beta-receptors are related to the hemodynamic of the vasculature of the lungs and cardiovascular system. The beta-blockade agents are one of the most common medication classes used for rate control in cardiac arrhythmias, but the side effect could be COPD exacerbation; on the other hand, beta-adrenergic or beta-agonist as a therapy for this pulmonary condition could increase the heart rate leading to AF decompensation. There is a clear dilemma in our patients who have airway disease and AF since the treatment for one might worsen the other. The clear benefit in morbidity and mortality of beta-blocker therapy, especially beta1-selective, outweighs the potential for any pulmonary side-effects related to ex-acerbation of COPD or airway disease. Conclusion: There is clear data showing the evidence of the potential paradoxical side-effect between COPD and AF therapies, given the exacerbation of one due to treatment of the other, benefits versus risks should be discussed and the medical decision should be made based on them. The deteriorated cardiac condition can rapidly predispose to critical complications leading to death, which is why the use of beta-blockade agents will be chosen over possible complications with pulmonary disease. In other words, the benefit should outweigh the risk based on the best outcome for the patient. Keywords: atrial fibrillation; pulmonary disease; obstructive pulmonary disease; chronic obstructive pulmonary disease (COPD); B-Agonist; B-Block (selective; non-selective); digitalis; other antiarrhythmic.