26 year old healthy adult presents for hernioraphy. History is normal, claims to be a slightly anxious personality and occasional palpitation when stressed. Effort tolerance is greater than 8 METS.
Clinical examination reveals no other problem except a resting heart rate of 145 bpm. Examined on several occasions and found to be consistently above 140 bpm
patient has normal CVS finding, ECG shows narrow complexed tachycardia, Xray is normal. All biochem including Thyroid function is within normal limits.
ECHO shows normal study exxcept for the tachycardia noticed during study.
Patient was initially started on Alprazolam 0.5 mg HS.
No improvement lead to additon of Tab. Propronalol 20 mg intitally OD and subsequently BD.
Propronalol, and not cardioselective beat blocker choosen for the complimentary CNS anti-stress effect of the drug
After 1 week rates continue to fluctutate between 130 and 140 bpm.
Do we proceed with this rate. or do we further need to stabilize his rate,
regs
Interesting case, my opinion:
obviously extreme bradycardia, would not take to OR until beta-blocker titrated up further (HR around 100 bpm). Other differential diagnoses needing to be ruled out:
pheochromocytoma
iatrogenic/medication related
drug abuse (cocaine, methamphetamine)
may require Holter monitoring to see if HR always that high (situational) and /or if any irregular rhythms.
interesting.. how about WPW, or reentry tachycardia OR sinus tachycardia? have you tried ivabradinum?
Back in reply mode after some time.
At a rate of 140 bpm, there is hardlly any time for a ventricle refill. But still he is maintaining all parameters.
The PUNDITS ( Cardios) must have evaluated him and given a go signal too.
I would prefer to give him an epidural block, which itself will give a sympathetic blockade and help me with a lower rate.
But again GA might be safer if we can give shorter acting Betablockers and manage the case.
I am sure u must have done the case by now.
We are all eager to know what you did and how.
Regards
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