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Metoprolol vs diltiazem

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    Metoprolol vs diltiazem


    By Najm Haque, PGY2 Atrial fibrillation with rapid ventricular response is a common emergency room problem. Patient with stable blood pressure who present in Afib with RVR need medications to control their heart rate (unstable patients require more cardioversion). Traditionally, these patients receive beta blockers or calcium channel blockers in IV form for rate control. The most common medications used in the US are metoprolol and diltiazem, but it is unclear which is superior. Fromm et al This study was published in the Journal of Emergency Medicine in April 2015 and compared how fast rate control was achieved in diltiazem vs metoprolol. This was a prospective, double-blind study which compared the effects of both medications at 30 minutes, as well as looking at mean decrease in heart rate, and adverse effects. Patients were randomized and either received Diltiazem 0.25 mg/kg IVP (maximum dose of 30mg) or Metoprolol 0.15mg/kg IVP (maximum dose of 10mg). prednisone to methylprednisolone BACKGROUND Diltiazem (calcium channel blocker) and metoprolol (beta-blocker) are both commonly used to treat atrial fibrillation/flutter (AFF) in the emergency department (ED). However, there is considerable regional variability in emergency physician practice patterns and debate among physicians as to which agent is more effective. To date, only one small prospective, randomized trial has compared the effectiveness of diltiazem and metoprolol for rate control of AFF in the ED and concluded no…

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    Relevant Article Fromm C, Suau SJ, Cohen V, et al. Diltiazem vs. metoprolol in the management of atrial fibrillation or flutter with rapid. ciprofloxacin cellulitis N° 1 - p. 80-84 - Metoprolol vs. diltiazem in the acute management of atrial fibrillation in patients with heart failure with reduced ejection fraction - EMconsulte. Diltiazem vs. metoprolol in the management of atrial fibrillation or flutter with rapid ventricular rate in the emergency department. J Emerg Med.

    Objective: To compare the effectiveness of intravenous (IV) diltiazem and metoprolol in the management of rapid ventricular rate in atrial fibrillation (AF). Methods: This prospective, randomised study was conducted in the Emergency Department of the Uludag University Medical Faculty Hospital, Bursa, Turkey. Forty AF patients with a ventricular rate ⩾120/minute and systolic blood pressure ⩾95 mm Hg were included and randomised to receive IV diltiazem 0.25 mg/kg (maximum 25 mg) or metoprolol 0.15 mg/kg (maximum 10 mg) over 2 minutes. Blood pressures and heart rate were measured at 2, 5, 10, 15, and 20 minutes. Successful treatment was defined as fall in ventricular rate to below 100/minute or decrease in ventricular rate by 20% or return to sinus rhythm. Results: Between January 2000 and July 2002, 40 patients (18 men, 22 women) met the inclusion criteria. Of these 20 (8 men, 12 women; mean age 60.2 years, range 31–82) received diltiazem and 20 (10 men, 10 women; mean age 64.0 years, range 31–82) received metoprolol. Authors’ Conclusions: “Diltiazem was more effective in achieving rate control in ED patients with AFF and did so with no increased incidence of adverse effects.” Key Results: There were 28 patients randomized to the metoprolol group and 24 in the diltiazem group. About two-thirds of the patients were new-onset atrial fibrillation. The mean age was 66 years, and 47 percent were men. No difference was noted between the groups in terms of bradycardia or hypotension. Ken Milne, MD, is chief of emergency medicine and chief of staff at South Huron Hospital, Ontario, Canada. He is on the Best Evidence in Emergency Medicine faculty and is creator of the knowledge translation project the Skeptics Guide to Emergency Medicine.

    Metoprolol vs diltiazem

    Diltiazem vs. Metoprolol in the Management of Atrial Fibrillation or., Metoprolol vs. diltiazem in the acute management of atrial fibrillation.

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  6. The results of the study showed that diltiazem reached the target HR of 100 much more frequently at 5 minutes 50% vs 10.7% and at 30 minutes 95.8% vs 46.4% when compared to metoprolol. There was no difference in adverse effects.

    • Dilt v. Metoprolol in Afib/RVR - Jacobi Emergency Medicine
    • Atrial Fibrillation with Diltiazem or Metoprolol? - The Skeptics.
    • SGEM#133 Just Beat It Atrial Fibrillation with Diltiazem.

    Summary. A double-blind, parallel-group multicentre study has been done to compare the antihypertensive properties, effects on serum lipoproteins and adverse effect profiles of diltiazem and metoprolol given as monotherapy to primary hypertensive patients. 128 patients were included from 10 participating centers. prednisone 5092 Compared with baseline, diltiazem treatment significantly reduced both. metoprolol and carvedilol improved neither frequency nor severity. Key Results There were 28 patients randomized to the metoprolol group and 24 in the diltiazem group. About two-thirds of the patients were new-onset atrial fibrillation. The mean age was 66 years, and 47 percent were men. Primary Outcome HR100 bpm at 30 minutes 96 percent diltiazem vs. 46 percent metoprolol number needed to treat=2

     
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