Managing Beta-blockers in Acute Heart Failure: When to Start and When to Stop?

Yılmaz, Mehmet; Laribi, Sai͏̈d; Mebazaa, Alexandre

doi:10.1007/s11897-010-0014-8

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…[2] Beta-blockers can be safely kept during acute decompensations unless decompensation is directly linked to beta-blockers or the patient is in cardiogenic shock. [19] Furthermore, a very recent analysis of the SURVIVE trial has shown that, in severe acutely decompensated patients with heart failure, who were admitted on beta-blockers, continuation of beta-blockers at discharge was associated with 1-month and 6-month mortality benefit. [20] Interesting enough, highest mortality was observed among patients who were admitted on beta-blockers, but were discharged without beta-blockers.…”

Section: Initial Managementmentioning

confidence: 99%

Very early management of acute heart failure syndromes

Yilmaz

Cohen-Solal²,

Mebazaa³

2011

Turk Kardiyol Dern Ars

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Diagnosis and management of acute heart failure syndromes are described in the most recent ESC/ESICM guidelines. However, physicians dealing with these patients in their daily practice may need guidance in choosing therapeutic alternatives as soon as the dyspneic patient arrives to the emergency department. Herein, practical recommendations for the very early management of patients with acute heart failure syndromes are presented. Blood pressure- and symptom-driven strategy along with early initiation of goal-directed therapies are key take-home messages. Furthermore, early and frequent reassessment is also an imperative part of management so that adjustments in the initial therapeutic plan can be achieved in a timely fashion.

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Section: Initial Managementmentioning

confidence: 99%

Very early management of acute heart failure syndromes

Yilmaz

Cohen-Solal²,

Mebazaa³

2011

Turk Kardiyol Dern Ars

Self Cite

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“…1,6 Beta blockers have several side effects, though, such as bronchoconstriction, slowing of heart rate and suppression of inotropy, 7 and beta blockers have proven to be dangerous in the setting of decompensated acute heart failure. 8 Nondihydropyridine calcium channel blockers should also not be used in acute atrial fibrillation with depressed systolic function, as they may impair cardiac conduction and inotropy even further. 1 Amiodarone is another agent that can be considered, but may take up to 7 hours to initiate rate control and has sympatholytic and atrioventricular nodal suppression properties, which make this agent hazardous in patients needing faster control with depressed systolic function.…”

Section: Introductionmentioning

confidence: 99%

A case report of successful digoxin use for fast atrial fibrillation to facilitate emergency surgery in a bleeding patient

Swart

2020

Southern African Journal of Anaesthesia and Analgesia

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Atrial fibrillation complicated by a fast ventricular response rate can cause a significant physiological burden. This is characterised by systolic pump failure, decreased diastolic filling time and hypotension leading to impaired organ perfusion. Considering that most anaesthetic agents are cardiac suppressants, the additive effects of this condition together with anaesthesia may lead to increased perioperative morbidity and mortality. A 79-year-old male patient who presented with atrial fibrillation, caused by chronic obstructive pulmonary disease and pulmonary hypertension, and a fast ventricular response rate was booked for emergency ligation of the sphenopalatine artery for posterior epistaxis, complicated by significant blood loss. Both electrical and pharmacological alternatives exist to address this conundrum, but here we would like to present this case where digoxin was used successfully to rate control this patient perioperatively. Digoxin has recently fallen into disfavour for the chronic management of atrial fibrillation, and even in select cases of acute atrial fibrillation with a fast ventricular response rate, and the purpose of this case study is to highlight a potentially useful indication for this antiquated drug.

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