The prognosis remains poor for many patients with congestive heart failure, despite maximal medical treatment with ACE inhibitor, diuretics and digitalis. In heart failure, activation of sympathetic nervous system has been described as one of the most important pathophysiologic abnormalities in patients with congestive heart failure and as one of the most important mechanisms that may be responsible for progression of heart failure. The use of beta blockers which may inhibit sympathetic activity, might reduce the risk of disease progression in heart failure, improve symptoms and increase survival. Several large clinical trials with metoprolol, carvedilol and bisoprolol have shown that long term use of these agents can improve left ventricular function and symptoms of CHF, it may also reduce hospital readmission and decrease mortality. Current guidelines recommend the use of beta blocker in mild, moderate and severe CHF, in the absence of contraindications or tolerance in combination with ACE inhibitor and diuretics. Beta blocker should be initiated in patients after maximal medical therapy with diuretics, ACE inhibitor and digitalis and patients already stabilized and in compensated conditions. Beta blocker should be started in low doses and require slow titration over weeks or months before patients can attain maintenance doses. leer más
Broad QRS complex tachycardia is tachycardia with widened QRS complex more than 12 s and caused by various mechanisms, either supraventricular or ventricular. It is important to differentiate between ventricular and supraventricular because it will determine treatment and prognosis of patients. We report a case which was referred to us and first diagnosed as ventricular tachycardia but happened to be atrial fibrillation with RBBB. On ECG examination we found irregular broad complex of tachycardia, RBBB, extreme right axis and heart rate 170-180 beat/minute. Intravenous bolus of 300 mg amiodarone was administered within 30 minutes and continued with 900 mg/24 hours. During administration of amiodarone, heart rhythm was converted to sinus rhythm with short PR interval (0.09 s), left axis deviation, and positive delta wave at lead V1. The final diagnosis of wolf-parkinson-white (WPW) syndrome was then confirmed. leer más
to see which component of the triad lipid that has more important role and frequently found in patients with acute coronary syndrome, focusing on HDL cholesterol. leer más
