Key result
Ivabradine lowers HR without affecting BP in hypotensive post-MI HF, enabling ARB and beta-blocker up-titration.
Why the study?
While beta-blockers and ARB/ACEI improve prognosis after acute myocardial infarction, their use can be limited, and ivabradine may play a potential role in improving individual prognoses when these therapies cannot be used.
Does ivabradine facilitate the titration of ARB/ACEI or beta-blockers in a patient with heart failure post-myocardial infarction and hypotension?
Case Report (n=1)
No
Does ivabradine facilitate the titration of ARB/ACEI or beta-blockers in a patient with heart failure post-myocardial infarction and hypotension?
In a post-myocardial infarction patient with heart failure and hypotension, ivabradine successfully reduced heart rate without lowering blood pressure, facilitating the up-titration of guideline-directed medical therapy.
May enable GDMT up-titration in select hypotensive post-MI HF cases; hypothesis-generating and requires prospective trials before practice change.
Introductionβ-blockers and angiotensin receptor blocker (ARB)/angiotensin-converting enzyme inhibitors (ACEI) are well known as critical therapies for improving the prognosis in patients with acute myocardial infarction, however, their use in some case may be limited. We believe that in such cases as when β-blockers and ARB/ACEI use is limited, ivabradine plays a potential role in the improvement of individual prognoses.Case PresentationA 49-year-old man from Dalian, China. He was diagnosed with acute inferior myocardial infarction in Feb, 2016. And he still experienced palpitations and heart failure after drug treatment and percutaneous coronary intervention (PCI). We used metoprolol at a low dose, although the symptoms were not relieved, β-blockers could not be used or increase dose because of his hypotension. Finally, we chose ivabradine to alleviate the symptoms of the patient related to heart rate and palpitations without affecting blood pressure so as to promote the recovery of heart function. We witnessed a gradual reduction in heart rate (HR) and a gradual increase in blood pressure. Finally, we administered an ARB and increased via titration the dose of ARB and β-blocker.ConclusionsWhen there are limitations to the use of ARB/ACEI and β-blockers, we can use ivabradine, which reduces HR without affecting blood pressure. Ivabradine can help with the titration of the dose of ARB/ACEI or β-blockers.
No takes yet. Share an insight, caveat, or question.
liu et al. (2020) conducted a case report in Heart failure after acute myocardial infarction (n=1). Ivabradine was evaluated on Heart rate and blood pressure changes allowing titration of ARB/ACEI or β-blockers. Ivabradine reduced heart rate without affecting blood pressure in a patient with post-MI heart failure and hypotension, enabling the up-titration of ARB and beta-blocker therapies.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: