441 An Atypical Case of Marantic Endocarditis in Undiagnosed Antiphospholipid Syndrome

Abstract

Background: The acute withdrawal of beta-blockers is known to precipitate sympathetic hyperresponsiveness. The use of these agents during acute exacerbations of chronic obstructive pulmonary disease (COPD) appears to be safe, however, there is ongoing concerns of their adverse respiratory effects. The true clinical impacts of the acute withdrawal of beta-blockers during these periods of systemic inflammation and respiratory distress are unknown. Method: A retrospective cohort study of patients that were hospitalised for acute exacerbations of COPD across two tertiary centres in Melbourne, Australia, over a 12-month period. Patient demographics, inpatient medication use, cardiac and respiratory outcomes were recorded. Results: 1071 patients met the inclusion criteria, of which, 276 patients (25.8%) were taking beta-blockers on admission. Of these, 23 (8.2%) had beta-blockers acutely ceased during admission. The most common indication for cessation was hypotension (12/23, 52.1%), followed by respiratory distress (8/23, 34.8%). Compared to those that continued beta-blockers throughout admission, acute withdrawal was associated with increased rates of atrial fibril