title: High dose neostigmine treatment of malignant sinus tachycardia.
abstract: Sinus tachycardia caused by circulating catecholamines in the setting of congestive heart failure may impair systemic perfusion because of decreased diastolic filling time. We report the case of a patient with Wolff-Parkinson-White syndrome with angina and cardiogenic shock who improved dramatically following administration of neostigmine. Cardiac output, blood pressure, and stroke volume increased as heart rate was reduced. A previous attempt at heart rate control, in the same patient, using a low dose beta-antagonist, precipitated hemodynamic collapse. The remarkable recovery of our patient suggests that acetylcholinesterase inhibitors may warrant further investigation in patients with severe sinus tachycardia.
authors.affiliation: Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: L W
authors.initials: LW
authors.lastname: Schultheis
authors.forename: J R
authors.initials: JR
authors.lastname: Balser
authors.forename: H
authors.initials: H
authors.lastname: Calkins
authors.forename: S
authors.initials: S
authors.lastname: Robertson
authors.forename: J L
authors.initials: JL
authors.lastname: Weiss
authors.forename: M
authors.initials: M
authors.lastname: Sussman
authors.forename: R S
authors.initials: RS
authors.lastname: Stuart
mesh_terms: D000328:Adult; D002395:Catecholamines / Q000097:blood; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D009388:Neostigmine / Q000008:administration & dosage*; D013616:Tachycardia, Sinus / Q000188:drug therapy* / Q000209:etiology
chemical_list: D002395:Catecholamines; D002800:Cholinesterase Inhibitors; D009388:Neostigmine