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Is Amiodarone an Alternative to Beta-Blockers to Treat Supraventricular Tachycardias in Pheochromocytoma?

Is Amiodarone an Alternative to Beta-Blockers to Treat Supraventricular Tachycardias in... Abstract To the Editor. —In the January 1984 Archives, Sloand and Taylor Thompson1 presented a case of unknown pheochromocytoma without histologic evidence of heart disease, in which propranolol hydrochloride—induced pulmonary edema and shock, leading to death. It is known that propranolol may cause pulmonary edema in patients with pheochromocytoma without having a previous α-blockade.2 As propranolol is a nonspecific betablocking drug, its administration in these patients may leave α-adrenergic effects unopposed.1,2 This could result in arterial vasoconstriction causing afterload increase and heart failure, that may lead to pulmonary edema2 and cardiogenic shock.1 Sloand and Taylor Thompson1 suggested that the use of a selective β1-blocker such as metoprolol tartrate, would be a theoretical alternative to propranolol. Additionally, propranolol has a negative inotropic effect and because of this action, it has been reported to precipitate severe heart failure in a patient with a pheochromocytoma plus a cardiomyopathy, that was under a-adrenergic References 1. Sloand EM, Taylor Thompson B: Propranolol-induced pulmonary edema and shock in a patient with pheochromocytoma. Arch Intern Med 1984;144:173-174.Crossref 2. Wark J, Larkins R: Pulmonary edema after propranolol therapy in two cases of pheochromocytoma. Br J Med 1978;1:1397-1398.Crossref 3. Gilsanz FJ, Luengo C, Conejero P, et al: Cardiomyopathy and phaeochromocytoma. Anaesthesia 1983;38:880-891.Crossref 4. Solares G, Ramos F, Martin-Duran R, et al: Amiodarone, phaeochromocytoma and cardiomyopathy. Anaesthesia 1986;41:186-190.Crossref 5. Zippes D, Prystowsky E, Heger J: Amiodarone: Electrophysiologic actions, pharmacokinetics and clinical effects. J Am Coll Cardiol 1984;3:1059-1071.Crossref 6. Cote T, Bourassa MG, Delaye J, et al: Effects of amiodarone on cardiac and coronary hemodynamics and on myocardial metabolism in patients with coronary artery disease. Circulation 1979;59:1165-1172.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Is Amiodarone an Alternative to Beta-Blockers to Treat Supraventricular Tachycardias in Pheochromocytoma?

Is Amiodarone an Alternative to Beta-Blockers to Treat Supraventricular Tachycardias in Pheochromocytoma?

Abstract

Abstract To the Editor. —In the January 1984 Archives, Sloand and Taylor Thompson1 presented a case of unknown pheochromocytoma without histologic evidence of heart disease, in which propranolol hydrochloride—induced pulmonary edema and shock, leading to death. It is known that propranolol may cause pulmonary edema in patients with pheochromocytoma without having a previous α-blockade.2 As propranolol is a nonspecific betablocking drug, its administration in these patients...
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Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360220267048
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. —In the January 1984 Archives, Sloand and Taylor Thompson1 presented a case of unknown pheochromocytoma without histologic evidence of heart disease, in which propranolol hydrochloride—induced pulmonary edema and shock, leading to death. It is known that propranolol may cause pulmonary edema in patients with pheochromocytoma without having a previous α-blockade.2 As propranolol is a nonspecific betablocking drug, its administration in these patients may leave α-adrenergic effects unopposed.1,2 This could result in arterial vasoconstriction causing afterload increase and heart failure, that may lead to pulmonary edema2 and cardiogenic shock.1 Sloand and Taylor Thompson1 suggested that the use of a selective β1-blocker such as metoprolol tartrate, would be a theoretical alternative to propranolol. Additionally, propranolol has a negative inotropic effect and because of this action, it has been reported to precipitate severe heart failure in a patient with a pheochromocytoma plus a cardiomyopathy, that was under a-adrenergic References 1. Sloand EM, Taylor Thompson B: Propranolol-induced pulmonary edema and shock in a patient with pheochromocytoma. Arch Intern Med 1984;144:173-174.Crossref 2. Wark J, Larkins R: Pulmonary edema after propranolol therapy in two cases of pheochromocytoma. Br J Med 1978;1:1397-1398.Crossref 3. Gilsanz FJ, Luengo C, Conejero P, et al: Cardiomyopathy and phaeochromocytoma. Anaesthesia 1983;38:880-891.Crossref 4. Solares G, Ramos F, Martin-Duran R, et al: Amiodarone, phaeochromocytoma and cardiomyopathy. Anaesthesia 1986;41:186-190.Crossref 5. Zippes D, Prystowsky E, Heger J: Amiodarone: Electrophysiologic actions, pharmacokinetics and clinical effects. J Am Coll Cardiol 1984;3:1059-1071.Crossref 6. Cote T, Bourassa MG, Delaye J, et al: Effects of amiodarone on cardiac and coronary hemodynamics and on myocardial metabolism in patients with coronary artery disease. Circulation 1979;59:1165-1172.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1986

References