Effect of Beta-blockers on Tachycardia in Patients with Pulmonary Embolism.

Abstract

HypothesisBeta-blockers (BBs) lower the heart rate, which may mask the diagnosis of pulmonary embolism (PE) since one of the main clinical diagnoses of PE is tachycardia. The endpoint of our retrospective study is to determine if the pre-existing use of (BB) significantly affects the utility of these scoring criteria in diagnosing PE.IntroductionDiagnosing PE is a challenge because of the non-specificity of its symptoms and signs. The initial step is to assess the patient’s likelihood of having a PE. This involves using a scoring system to stratify patients into different levels of risk of having PE (for example, as ‘low,’ ‘moderate,’ or ‘high’ risk). Some of the commonly used criteria are Wells’ Score, Geneva Score, and Pulmonary Embolism Rule-out Criteria (PERC) Rule (Charlotte Rule).MethodologyThis retrospective study was conducted at St. Francis Medical Center. Subjects were taken from a patient population with a new diagnosis of PE (between 2010 and 2017) on the basis of computed tomography angiography (CTA) of the chest. Patients with sepsis or septic shock, heart block, atrioventricular (AV) nodal ablation, pacemaker placement, or taking more than one AV nodal blocker were excluded from the study. Subjects were categorized on the basis of beta-blocker consumption.ResultOut of a total of 170 cases, 71 patients were taking beta-blockers and 99 patients were not taking beta-blockers. Among the participants taking BBs, 30.4% had a heart rate <60 and 55.8% had a heart rate between 60 and 100.ConclusionBBs significantly obviate tachycardia in patients with PE. It falsely decreases the Wells’ Score and the Geneva Score and results in the inappropriate fulfilling of PERC criteria.