گزارش موردی درباره تخمین ضربان قلب بهینه در نارسایی قلبی
Abstract
Introduction
Case report
Discussion
References
Abstract
Relative bradycardia (mild sinus bradycardia) is one of the major barriers for the effective treatment of hemodynamically unstable patients with heart failure and reduced cardiac output. We report a case of a man aged 58 years with an old broad anterior myocardial infarction and relative bradycardia (about 60 bpm) suffering from symptoms of congestive heart failure at rest in spite of optimal medical therapy, including the use of the inotropes. Transvenous atrial pacing during right heart catheterization indicated that an increase in heart rate (up to 80 bpm) improved hemodynamics immediately. Implantation of a pacemaker (atrial pacing of 80 bpm) was effective for stabilizing the heart failure symptoms. Transvenous atrial pacing during right heart catheterization is effective for estimating the optimal heart rate in patients with heart failure and relative bradycardia. <Learning objective: Temporary atrial pacing during right heart catheterization is effective for estimating the optimal heart rate in patients with refractory heart failure and relative bradycardia. We present a case of inotrope-dependent heart failure. Our findings, obtained through echocardiography and right heart catheterization, showed dramatic improvements in hemodynamic parameters following an increase in heart rate via a cardiac pacemaker. This case assesses the impact of optimal heart rate in severe heart failure with relative bradycardia.>
Introduction
Bradycardia is one of the exacerbating factors of heart failure, especially in patients with underlying heart disease [1]. Severe bradycardia that is clearly adversely influencing a patient’s hemodynamic status is an absolute indication for insertion of a permanent cardiac pacemaker. However, this is not necessarily true for heart failure patients with relative bradycardia. There are several reasons for this. Firstly, patients have no symptoms of bradycardia itself. Secondly, it is unclear whether augmentation of cardiac output by increasing heart rate is a sufficient indication for implantation of a pacemaker. Furthermore, the optimal dose of beta-blockers is also uncertain in such cases. Here we report a patient with severe heart failure and relative bradycardia in whom increasing the heart rate by atrial pacing (from 60 to 80 bpm) greatly improved his hemodynamics and symptoms.