title: Autonomic antecedents to variant angina exacerbation after beta-blockade withdrawal.
abstract: We describe a patient with nonsignificant coronary artery disease who experienced variant angina after beta -blockade withdrawal. Standard therapy with nifedipine and nitrates aimed at suppressing symptoms and typical transient ST-segment elevations was superseded by the reinstitution of metoprolol. The autonomic alternations before and after readministration of metoprolol were analyzed by time and spectral indices of heart rate variability (HRV). Metoprolol reduced the HRV and reversed the low-frequency/high-frequency power ratio toward a more physiological autonomic balance. We conclude that the reinstitution of beta -blocker acted protectively by preventing surges of sympathetic activity on an underlying basis of parasympathetic predominance.
authors.affiliation: Cardiology Department, Patras University Hospital Rio-Patra, Greece. chil@otenet.gr
authors.forename: John A
authors.initials: JA
authors.lastname: Chiladakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000788:Angina Pectoris, Variant / Q000139:chemically induced*; D001341:Autonomic Nervous System / Q000187:drug effects; D003329:Coronary Vasospasm / Q000139:chemically induced; D004562:Electrocardiography / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use; D009566:Nitrates / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D009566:Nitrates; D014665:Vasodilator Agents; D008790:Metoprolol; D009543:Nifedipine