Administration Of Beta-blockers Research Articles

A regional quality improvement effort to increase beta blocker administration before vascular surgery

To determine if a regional quality improvement effort can increase beta-blocker utilization prior to vascular surgery and decrease the incidence of postoperative myocardial infarction (POMI). A quality improvement effort to increase perioperative beta blocker utilization was implemented in 2003 at centers participating in the Vascular Study Group of New England (VSGNE). A 90% target was set and feedback given at biannual meetings. Beta blocker utilization (<1 month preoperative versus chronic) and POMI rates were prospectively collected for patients undergoing open abdominal aortic aneurysm (AAA) repair (n = 926) and lower extremity bypass (LEB; n = 2,123) from 2003 through 2008. Predictors of POMI were determined using multivariate logistic regression. Rates of beta blocker administration and POMI were analyzed over time, and across strata of patient risk based on a multivariate model. Perioperative beta blocker treatment increased from 68% of patients in the first 3 months of 2005 to 88% by the last 3 months of 2008 (P < .001). In 2003, 44% of patients not on chronic beta blockers were treated with preoperative beta blockers; by 2008, 78% of patients not on chronic beta blockers were started perioperatively on these medications (P < .001). Beta blocker utilization increased across all centers and surgeons participating during the study period, and increased in patients of low, medium, and high cardiac risk. However, the rate of POMI did not change over time (5.2% in 2003, 5.5% in 2008; P = .876), although a trend towards lower POMI rate was seen in patients on preoperative beta blockers (4.4% in 2003-2005, 2.6% in 2006-2008; P = .43). In multivariable modeling we found that age >70 (odds ratio [OR], 2.1), positive stress test (OR, 2.2), congestive heart failure (CHF; OR, 1.7), chronic beta blocker administration (OR, 1.7), resting heart rate <70 (OR, 1.8), and diabetes (OR, 1.6) were associated with POMI. Resting heart rate was similar for patients on chronic (67), preoperative (70), and no beta blockers (70; P = .521). Our regional quality improvement effort successfully increased perioperative beta blocker utilization. However, this was not associated with reduced rates of POMI or resting heart rate. While this demonstrates the effectiveness of regional quality improvement efforts in changing practice patterns, further work is necessary to more precisely identify those patients who will benefit from beta blockade at the time of vascular surgery.

¿Betabloqueante oral o intravenoso en coronariografía mediante tomografía computarizada? Un estudio prospectivo y aleatorizado

Objectives To determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. Material and methods This was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. Results The median (interquartile range) overall time was 120 (100-150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5-67.5) minutes in the 21 patients who received intravenous beta-blockers (p < 0.001). The median time that patients were in the CT examination room was 10 (6-15) minutes in Group 1 and 10 (9-20) minutes in Group 2 (p = 0.57). The decrease in mean arterial pressure was 10 mmHg after the administration of intravenous beta-blockers compared to 3.3 mmHg after the administration of oral beta-blockers (p = 0.01). No significant differences were found in the diagnostic quality of the examinations. Conclusions The time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations.

Considerations in treating acute coronary syndromes with possible coexisting asthma

When a patient presents with symptoms of an acute coronary syndrome (ACS) routine administration of antiplatelet and betablocking therapy is recommended according to the NICE guidance ( Cooper 2010 ). However certain comorbid conditions that may point to underlying asthma should be considered and the risk:benefit ratio assessed before administration of routine aspirin prophylaxis and betablockers on diagnosis of ACS. Bronchial hyperreactivity in response to betablockers and/or aspirin may result in rapid bronchospasm, severe dyspnoea and possible death in susceptible individuals. The presence of allergic rhinitis, nasal polyposis and chronic rhinosinusitis must be considered in the overall assessment and where a decision to treat is made, cardio-selective betablockers should be initiated at very low doses with close monitoring.

Is it possible to decrease the incidence of peri-operative stroke associated with acute peri-operative beta-blocker administration?

Is it possible to decrease the incidence of peri-operative stroke associated with acute peri-operative beta-blocker administration?

Current drug therapies for infantile hemangioma: focused on beta blocker

I hemangioma (IH), a common vascular tumor from vascular birth marks, used to be untreated due to its natural course of spontaneous regression with few exceptions like cosmetic disfigurement, functional or life impairment. It has been treated through a variety of methods like the topical and systemic corticosteroid, surgery, laser, etc. Among them, systemic corticosteroid, which has been used most commonly, may sometimes cause troublesome side effects such as temporary growth retardation or personality change, so it is often clinically inapplicable. Recently, however, it was reported that treatment using beta blocker for IH is more effective with fewer side effects than conventional treatments. Oral beta blocker has been used for IH patients who concerns about presenting ulcerative lesions, impending cosmetic sequelae or functional and life impairment. Before the administration of beta blocker, the patient goes through inquiry about clinical history, physical examination, electrocardiogram and echocardiography in order to determine the applicability. During the hospital stay, vital signs and blood glucose level are checked regularly to rule out side effects of beta blocker, and the dosage is increased gradually up to 2 mg/kg/day and the same dose is maintained continuously after discharge with same dosage. After considering many previous studies about beta blocker for IH patients, we reached an interim conclusion. The treatment of IH using beta blocker is effective, highly satisfactory and safe with no side effects though the selection from various beta blockers, evaluation methods of therapeutic efficacy and its duration and end point of treatment need to be confirmed.

Oral versus intravenous beta-blockers for computed tomography coronary angiography? A randomized controlled trial

ObjectivesTo determine whether the time employed in the radiological management of outpatients undergoing computed tomography (CT) coronary angiography varies in function of whether oral or intravenous beta-blockers are administered. Material and methodsThis was a prospective, analytical, randomized controlled trial. A total of 40 patients with heart rates greater than 65 beats per minute were randomly assigned to one of two groups. Patients in group 1 were administered oral beta-blockers and patients in group 2 were administered intravenous beta-blockers. We measured the overall time from entry to the radiology department to exit from the CT examination room. We also measured heart rate, blood pressure, and the number of conclusive studies. ResultsThe median (interquartile range) overall time was 120 (100–150) minutes in the 19 patients who received oral beta-blockers compared to 35 (27.5–67.5) minutes in the 21 patients who received intravenous beta-blockers (p < 0.001). The median time that patients were in the CT examination room was 10 (6–15) minutes in Group 1 and 10 (9–20) minutes in Group 2 (p=0.57). The decrease in mean arterial pressure was 10mmHg after the administration of intravenous beta-blockers compared to 3.3mmHg after the administration of oral beta-blockers (p=0.01). No significant differences were found in the diagnostic quality of the examinations. ConclusionsThe time employed in the radiological management of patients undergoing CT coronary angiography is significantly lower when beta-blockers are administered intravenously. There was no difference in the time patients were in the CT examination room or in the diagnostic quality of the examinations.

Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy

Infantile haemangioma therapy has long been a wait-and-see policy. Since recent development of laser and light therapy, pulsed dye laser has been successfully used for treating superficial haemangiomas. Few studies have been published about treatment with intense pulsed light (IPL) to assess the risk/benefit of IPL in the treatment of infantile haemangiomas during their early proliferative phase. In the present retrospective cohort study, we retrieved data about a series of 14 Caucasian children (median age: 4.8 months) with infantile haemangiomas treated with Photoderm Vasculight flash lamp. All patients experienced a rapid regression of the haemangiomas after 3 treatments on average. Few adverse events were noted, including ulceration and crusts. No residual scarring and cosmetic damages were noticed. Fast growing haemangiomas should be treated with light therapy as soon as possible. This technology is safe, efficient, inducing regression, and preventing any further functional and aesthetic complications. The benefit-risk ratio favours the treatment of most types of haemangiomas which are out of the scope of betablocker administration.

Effects of Beta-Blocker on Cardiorespiratory Fitness Factors and Blood Lipid of Patients with Acute Coronary Syndrome

The purpose of this study is to investigate effects of beta-blocker prescribed at the beginning of cardiac rehabilitation exercise for patients with acute coronary syndrome (ACS) on cardiorespiratory fitness factors and blood lipid at the 6th and the 14th week. The subjects of this study were patients (beta blocker group: n=20, non-beta blocker group: n=22) who underwent internal procedure because of ACS. The patients were conducted of exercise stress test and blood lipid before cardiac rehabilitation (the first period), were additionally prescribed of beta-blocker by cardiologist at the first week, and were conducted of exercise stress test and blood lipid at the 6th (the second period) and the 14th (the third period) week. Based on the results of this study, rest heart rate, maximal rate pressure product, sub-maximal rate pressure product, time and rate of perceived exertion showed no significant differences between groups, but peakVO2 showed interaction effect between treatment and period. All the items of blood lipid showed no differences between the groups. Conclusively, the group of beta-blocker administration showed negative effect on increase in peakVO2 at the 6th week but had positive effect at the 14th week. Meanwhile, beta-blocker did not affect blood lipid. Therefore, when patients with cardiovascular disease were additionally administered of beta-blocker at earlier period of cardiac rehabilitation, it may be needed of training time of at least six weeks to increase peakVO2.

Evaluation of coronary in-stent restenosis by 64-slice computed tomography in patients with optimal heart rate control by systematic administration of beta-blocker drugs

Imaging artifacts due to metallic stent struts can reduce the diagnostic accuracy of multislice computed tomography (MSCT) in the evaluation of in-stent restenosis (ISR). Our aim was to determine the accuracy of binary ISR exclusion using a 64-slice MSCT scanner and a systematic administration of beta-blockers having an aggressive heart rate (HR) control. We performed 64-slice MSCT in 218 consecutive patients revascularized by stenting. All patients were treated with oral/intravenous beta-blocker drugs in order to obtain a HR less than 65 beats/min in the prescan phase. Coronary stents were evaluated by two experienced observers in order to rule out the presence of significant (>50%) ISR. Quantitative conventional coronary angiography (CCA) served as a standard for reference. Five patients (2.3%) were excluded from the analysis; mean HR was 59 +/- 3 beats/min in the prescan phase and 62 +/- 5 beats/min during acquisition. In the 321 stented coronary segments, CCA found 27 significant ISRs. MSCT correctly diagnosed 26 significant ISRs, with two false-positive and one false-negative case. In a per-segment analysis, the sensitivity was 96%, specificity 99%, positive predictive value (PPV) 92.8%, and negative predictive value (NPV) 99%. In a per-patient analysis, the sensitivity was 100%, specificity 98.9%, PPV 92.8%, and NPV 100%. In our study, the evaluation of significant ISR by MSCT showed an excellent diagnostic accuracy with a PPV of 92.8% and a NPV of 99%. Selection criteria and radiation exposure can be considered a limitation of the method.

Deleterious Effects of Beta-Blockers on Survival in Patients With Cirrhosis and Refractory Ascites†,‡

Beta-blockers may have a negative impact on survival in patients with cirrhosis and refractory ascites. The aim of this study was to evaluate the effect of the administration of beta-blockers on long-term survival in patients with cirrhosis and refractory ascites. We performed a single-center, observational, case-only, prospective study of patients with cirrhosis and refractory ascites who did or did not receive beta-blockers for the prevention of gastrointestinal bleeding; 151 patients were included. The mean Model for End-Stage Liver Disease score was 18.8 +/- 4.1. All patients regularly underwent large-volume paracentesis and intravenous albumin administration. Seventy-seven patients (51%) were treated with propranolol (113 +/- 46 mg/day). The median follow-up for the whole group was 8 months. The median survival time was 10 months [95% confidence interval (CI) = 8-12 months]. The probability of survival at 1 year was 41% (95% CI = 33%-49%). The clinical characteristics and laboratory values at enrolment were not significantly different between patients who were receiving propranolol and those who were not. The median survival time was 20.0 months (95% CI = 4.8-35.2 months) in patients not treated with propranolol and 5.0 months (95% CI = 3.5-6.5 months) in those treated with propranolol (P = 0.0001). The 1-year probability of survival was significantly lower in patients who received propranolol [19% (95% CI = 9%-29%)] versus those who did not [64% (95% CI = 52%-76%), P < 0.0001]. The independent variables of mortality were Child-Pugh class C, hyponatremia and renal failure as causes of refractory ascites, and beta-blocker therapy. The use of beta-blockers is associated with poor survival in patients with refractory ascites. These results suggest that beta-blockers should be contraindicated in these patients.

Accuracy of low-dose prospectively gated axial coronary CT angiography for the assessment of coronary artery stenosis in patients with stable heart rate

Desirable methods for cardiac CT angiography would both reduce radiation exposure from cardiac CT angiography and preserve accuracy. We assessed image quality, radiation dose, and diagnostic accuracy of a low-dose, prospectively gated axial cardiac CT angiography protocol for the evaluation of patients with suspected coronary artery disease (CAD). Fifty consecutive patients referred for diagnostic invasive coronary angiography (ICA) and with a stable heart rate < 60 beats/min after beta-blocker administration were prospectively enrolled in a single center study. Subjects underwent CT angiography with a 64-row multidetector CT scanner with a prospectively gated axial imaging protocol. If the examination was determined to be nondiagnostic, then a retrospectively gated helical scan was performed. Two reviewers independently assessed image quality and the presence of significant coronary artery stenosis (>50%). Prospectively gated CT angiography was successfully performed in 46 of 50 patients. Of 794 coronary segments, 777 were determined to be of diagnostic image quality. The overall patient-based sensitivity (95% CI), specificity, positive predictive value, negative predictive value, and accuracy for the diagnosis of significant coronary stenosis were 100% (87%-100%), 75% (53%-90%), 81% (64%-93%), 100% (81%-100%), and 88% (81%-95%), respectively. The mean effective radiation dose for CT angiography and ICA were 3.4 +/- 0.4 mSv and 6.9 +/- 0.8 mSv, respectively. Cardiac CT angiography performed in a prospectively gated axial mode with 64-row multidetector CT provides an accurate, low-dose alternative for the detection of CAD.

AS-262: Impact of Beta-Blockers on Acetylcholine-Induced Coronary Artery Spasm

Previous studies have reported that beta-blockers can aggravate variant angina and should be used cautiously in patients who may have variant angina. However, the impact of the pretreated beta-blockers on coronary artery spasm (CAS) with the intracoronary acetylcholine (Ach) provocation test has not been fully evaluated. We investigated whether the administration of beta-blockers may increase the incidence of CAS with the intracoronary Ach provocation test.

Perioperative Organprotektion – Beta-Blocker und Statine

The number of patients with limited organ function is steadily increasing due to the aging of the population. Consequently, a growing number of patients needing surgery is accompanied by serious comorbidities. These patients are at high risk of perioperative organ dysfunction. In this context cardiac events (e.g. cardiac arrhythmias, angina or myocardial infarction) play a major role with significant impact on postoperative care, long term outcome and economic sequelae. Thus, anaesthesiologists must prevent such events in the perioperative period. Besides general measures such as adequate analgesia, protection from stressful events and sufficient volume replacement, medical intervention with beta-blockers or HMG-CoA-reductase-inhibitors (statins) are necessary to reduce the incidence of perioperative cardiac events. Both beta-blockers and HMG-CoA-reductase-inhibitors are known to exhibit pleiotropic effects (defined as additional cardioprotective effects) besides the primary blockade of the beta-adrenergic receptor or the inhibition of the synthesis of serum cholesterol, respectively. Both groups of drugs improve cardiac function, decrease inflammatory response, decrease activation of blood coagulation and stabilize endothelial plaques. Based on the current literature the following recommendations are published concerning the perioperative administration of beta-blockers: (i) Patients who are on beta-blockers on a regular basis following guidelines concerning chronic treatment of cardiovascular diseases should continue this medication throughout the perioperative period; (ii) a sufficient indicator of an adequate therapy is the baseline heart rate. It should not exceed 60-70bpm at rest; (iii) the Revised Cardiac Risk Index (RCRI) is a widely accepted score to estimate the patient's perioperative cardiac risk; (iv) patients with a RCRI > or =3 should not be scheduled for routine surgery without sufficient beta-adrenergic-receptor blockade; (v) in patients at high cardiac risk based on the RCRI who are scheduled for emergency surgery beta-blocker-therapy should not be initiated de novo perioperatively. However, for perioperative treatment of tachycardia or hypertension beta-blockers are the drug of first choice. Concerning perioperative statin-therapy the following recommendations are suggested: (i) chronic statin-therapy should be continued throughout surgery and the perioperative period; (ii) in patients without chronic statin-therapy scheduled for vascular surgery this treatment should be started perioperativly; (iii) no data is available concerning other patient populations; (iv) if statin-therapy is indicated it should be started independently from baseline serum LDL-C-concentration; (v) side effects of statin-therapy are rare and usually not live threatening, thus treatment is considered to be without serious risks to the patient.

Possible indications of beta-blockers in the perioperative period other than prevention of cardiac ischemia

According to the guidelines of the American College of Cardiology/American Heart Association 2006 for perioperative cardiovascular evaluation for non-cardiac surgery, beta-blocker therapy should be considered for high-risk individuals undergoing vascular surgery or high- and intermediate-risk patients undergoing non-cardiac surgery. This guideline might induce physicians to increasingly use beta-blockers in the hope of preventing perioperative cardiac complications. However, beta-blockers have potential beneficial effects outside the prevention of cardiac events. In addition to reducing anesthetic and analgesic requirements during the perioperative period, beta-blockers have neuroprotective effects in patients with brain trauma and possible effectiveness in the management of intraoperative awareness-induced post-traumatic stress disorder. Moreover, intrathecal administration of beta-blockers may have antinociceptive effects. Physicians need to bear in mind the benefits of beta-blockers for purposes other than preventing cardiac events when applied in the perioperative period, and they should be familiar with the pharmacodynamics and risk-benefit ratio with their use. This review focuses on possible extracardiac indications of beta-blockers.

Time for Reassessment: A Review of Beta-blockers in the Setting of Cocaine Associated Chest Pain and Acute Coronary Syndrome

Cocaine is the second most commonly used illicit drug in the United States, 1 and is the most frequent illicit substance to precipitate an emergency room visit, responsible for over 550,000 visits in 2007 alone. 2 The majority of patients present with a chief complaint of chest pain3, and approximately 6% are diagnosed with cocaine associated myocardial infarction.4For decades it has been thought that beta-blockade in the setting of cocaine use would precipitate coronary vasospasm and worsen cardiovascular outcomes due to unopposed alpha receptor stimulation. In 1999 this thinking was incorporated into the ACC/AHA guidelines, which currently recommend beta-blockers in all patients with an acute coronary syndrome except in the setting of prior cocaine use.4 Recently there have been several studies suggesting benefit from beta-blocker administration in patients with cocaine associated chest pain and myocardial ischemia.

Effect of oral beta-blocker on short and long-term mortality in patients with acute respiratory failure: results from the BASEL-II-ICU study

IntroductionAcute respiratory failure (ARF) is responsible for about one-third of intensive care unit (ICU) admissions and is associated with adverse outcomes. Predictors of short- and long-term outcomes in unselected ICU-patients with ARF are ill-defined. The purpose of this analysis was to determine predictors of in-hospital and one-year mortality and assess the effects of oral beta-blockers in unselected ICU patients with ARF included in the BASEL-II-ICU study.MethodsThe BASEL II-ICU study was a prospective, multicenter, randomized, single-blinded, controlled trial of 314 (mean age 70 (62 to 79) years) ICU patients with ARF evaluating impact of a B-type natriuretic peptide- (BNP) guided management strategy on short-term outcomes.ResultsIn-hospital mortality was 16% (51 patients) and one-year mortality 41% (128 patients). Multivariate analysis assessed that oral beta-blockers at admission were associated with a lower risk of both in-hospital (HR 0.33 (0.14 to 0.74) P = 0.007) and one-year mortality (HR 0.29 (0.16 to 0.51) P = 0.0003). Kaplan-Meier analysis confirmed the lower mortality in ARF patients when admitted with oral beta-blocker and further shows that the beneficial effect of oral beta-blockers at admission holds true in the two subgroups of patients with ARF related to cardiac or non-cardiac causes. Kaplan-Meier analysis also shows that administration of oral beta-blockers before hospital discharge gives striking additional beneficial effects on one-year mortality.ConclusionsEstablished beta-blocker therapy appears to be associated with a reduced mortality in ICU patients with acute respiratory failure. Cessation of established therapy appears to be hazardous. Initiation of therapy prior to discharge appears to confer benefit. This finding was seen regardless of the cardiac or non-cardiac etiology of respiratory failure.Trial registrationclinicalTrials.gov Identifier: NCT00130559

Temporal heart rate reduction and blood pressure change on 64-row cardiac multidetector-row CT(MDCT)examination under oral administration of beta-blocker

Temporal heart rate reduction and blood pressure change on 64-row cardiac multidetector-row CT(MDCT)examination under oral administration of beta-blocker

Does the Early Administration of Beta‐blockers Improve the In‐hospital Mortality Rate of Patients Admitted with Acute Coronary Syndrome?

Beta-blockade is currently recommended in the early management of patients with acute coronary syndromes (ACS). This was a systematic review of the medical literature to determine if early beta-blockade improves the outcome of patients with ACS. The authors searched the PubMed and EMBASE databases for randomized controlled trials from 1965 through May 2009 using a search strategy derived from the following PICO formulation of our clinical question: Patients included adults (18+ years) with an acute or suspected myocardial infarction (MI) within 24 hours of onset of chest pain. Intervention included intravenous or oral beta-blockers administered within 8 hours of presentation. The comparator included standard medical therapy with or without placebo versus early beta-blocker administration. The outcome was the risk of in-hospital death in the intervention groups versus the comparator groups. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. In-hospital mortality rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) between beta-blockers and controls. Statistical analysis was done with Review Manager V5.0. Eighteen articles (total N = 72,249) met the inclusion/exclusion criteria. For in-hospital mortality, RR = 0.95 (95% CI, 0.90-1.01). In the largest of these studies (n = 45,852), a significantly higher rate (p < 0.0001) of cardiogenic shock was observed in the beta-blocker (5.0%) versus control group (3.9%). This systematic review failed to demonstrate a convincing in-hospital mortality benefit for using beta-blockers early in the course of patients with an acute or suspected MI.

Restoration of neutrophil immunocompetence after cardiopulmonary bypass by beta-adrenergic blockers

To evaluate the possible protective effect of sympatholytic medications with respect to neutrophil function, we evaluated the influence of a nonselective beta-blocker medication on the interaction of neutrophils and epinephrine after cardiopulmonary bypass. Therefore, we studied the importance of adrenoceptors for the immunomodulation of neutrophils by catecholamines in vitro. First, we investigated the modulation of neutrophils from healthy volunteers, after stimulation with n-formyl-l-methionyl-l-leucyl-l-phenylalanin (FMLP) in the presence of epinephrine with or without the addition of one of the following adrenergic receptor antagonists: atenolol, butoxamine, pindolol, prazosin, or RS79984. The second part included an investigation of the modulation of neutrophils from patients after operative coronary revascularization with or without extracorporeal circulation after stimulation with FMLP and addition of epinephrine. After loading with anti-CD62l or anti-CD11b antibodies or dihydrorhodamine, the expression of CD62l and CD11b and generation of oxidative free radicals were assessed by flow cytometry. The suppression of oxidative free radical generation, inhibition of CD62l downregulation after stimulation with FMLP, and suppression of CD11b upregulation after FMLP stimulation from epinephrine were all mediated by beta(2)-adrenoceptors. After cardiac surgery with cardiopulmonary bypass, epinephrine inhibited the CD62l downregulation, the suppression of CD11b upregulation, and the generation of oxidative free radicals after FMLP stimulation. The pre-operative administration of beta-blockers abolished the immunomodulatory effects of epinephrine on CD62l and CD11b expression and the generation of oxidative free radicals. The immunomodulatory effects of epinephrine on neutrophils remained unchanged irrespective of cardiopulmonary bypass and could contribute to the detrimental effects of epinephrine after heart surgery. The preoperative administration of nonselective beta-blockers abolished the immunomodulatory effects of epinephrine in vitro and in patients, and it enhanced the immunocompetence of neutrophils in a context of increased catecholamine levels.

Molar Pregnancy-Induced Thyroid Storm

Molar pregnancy is a rare form of pregnancy, affecting approximately 1 in 1000 pregnancies in the United States. Hyperthyroidism is a rare complication of molar pregnancy; thyroid storm occurs even less frequently. To discuss a rare cause of thyroid storm in a woman of reproductive age. A 17-year-old girl presented to a community hospital's Emergency Department (ED) after experiencing 1 week of palpitations and tachycardia. The tachycardia partially responded to administration of calcium channel blockers and beta-blockers. The patient was transferred to a tertiary care center for further evaluation. At the tertiary center, pregnancy was confirmed, thyroid storm was diagnosed, and ultrasound examination yielded a snowstorm image, indicating a molar pregnancy. The patient was admitted to the intensive care unit for management. Dilatation and curettage resolved her symptoms, and after a 9-day hospital stay, she was discharged home on atenolol therapy. Thyroid storm induced by gestational trophoblastic disease should be considered in any woman of childbearing age who presents with symptoms suggestive of hyperthyroidism.