1998/06/01 by Karl Swedberg · 1 citation
Medicine · #Heart Failure Treatment and Management #Cardiac electrophysiology and arrhythmias #Cardiac pacing and defibrillation studies #Medicine #Metoprolol #Heart failure #Dilated cardiomyopathy #Cardiology #Carvedilol #Internal medicine #Digitalis #Practolol #Digoxin #Cardiomyopathy #Anesthesia #Propranolol
paper · pdf · doi:10.1136/hrt.79.2008.29s
openalex publication_date 1998/06/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/14
Twenty years ago, digitalis and diuretics were the mainstay of therapeutic options for patients with idiopathic dilated congestive cardiomyopathy and advanced heart failure. Vasodilator treatment was yet to be established and cardiac transplantation was in its infancy. The historical basis for using β blockers to treat heart failure dates back to 1973 when a single bolus injection of practolol was administered to reduce the heart rate of a 59 year old woman with tachycardia caused by an acute pulmonary oedema owing to dilated cardiomyopathy. 1 The patient was successfully maintained on a twice daily oral regimen of alprenolol, which dramatically improved her heart failure. The patient was later switched to the cardioselective β blocker metoprolol. At 82 years old her condition remains stable on metoprolol, enalapril, diuretics, and digitalis. The clinical outcome of the first seven patients to be treated with β blockers were described in 1975. 1 Six patients received oral practolol 50‐400 mg twice daily and one received alprenolol 50 mg twice daily. The duration of treatment ranged from 2‐12 months (mean, 5.4 months). All seven patients experienced an improvement in their clinical condition shortly after starting treatment. This was accompanied by haemodynamic evidence of improved ventricular function with progressive improvement in functional capacity and a reduction in heart size. Based on these preliminary findings a formal, open label study of metoprolol was conducted in 28 patients with heart failure caused by congestive cardiomyopathy, 23