Treatment of milrinone-associated tachycardia with beta-blockers

To describe a case of milrinone-associated tachycardia that was successfully treated with two beta-blockers.

A 74-yr-old male patient underwent elective abdominal aortic aneurysm repair under combined epidural/general anaesthesia. He had a history of alcohol abuse, controlled hypertension and ischaemic heart disease. Postoperatively, the patient had persistent sinus tachycardia that was initially unsuccessfully treated with metoprolol. Subsequently, the patient's blood pressure and cardiac index decreased with an associated increase in pulmonary artery pressure. Analysis of the ST-segment revealed no evidence of myocardial ischaemia or infarction. These haemodynamic changes were treated with milrinone which exacerbated the baseline tachycardia without adverse blood pressure response. The subsequent administration of beta-blockers (esmolol and metoprolol) was successful in controlling the heart rate response to milrinone without adversely affecting the patient's haemodynamic profile.

This report demonstrates the efficacy of esmolol and metoprolol for the treatment of milrinone-associated tachycardia, without compromising the haemodynamic effects of milrinone.