From the Guidelines
For a 35-year-old male with palpitations, tachycardia (pulse 130), and hypertension (BP 149/92), the initial treatment should focus on administering a beta-blocker such as metoprolol 25-50 mg orally to reduce heart rate and blood pressure, as recommended by the 2017 ACC/AHA/HFSA guideline 1. This approach is supported by the fact that beta-blockers have been shown to improve outcomes in patients with heart failure and are effective in lowering blood pressure, as stated in the 2017 ACC/AHA/HFSA guideline 1. The patient's symptoms and presentation suggest the need for immediate management of both the tachycardia and hypertension. Key considerations in the management of this patient include:
- Identifying and addressing the underlying cause of the palpitations and tachycardia
- Managing symptoms to prevent morbidity and mortality
- Improving quality of life by reducing the frequency and severity of palpitations Some important steps in the management of this patient include:
- Performing a 12-lead ECG to determine the underlying rhythm and guide further management
- Conducting blood tests, including electrolytes, thyroid function, and cardiac enzymes, to rule out metabolic causes or myocardial injury
- Considering the use of other medications, such as calcium channel blockers or antiarrhythmic medications, depending on the specific diagnosis and patient presentation It is also important to note that nondihydropyridine calcium channel blockers, such as verapamil and diltiazem, are not recommended in patients with hypertension and heart failure with reduced ejection fraction, as stated in the 2017 ACC/AHA/HFSA guideline 1. Instead, beta-blockers, ACE inhibitors, and angiotensin receptor-neprilysin inhibitors are preferred for the management of hypertension and heart failure, as recommended by the 2017 ACC/AHA/HFSA guideline 1 and the 2007 American Heart Association scientific statement 1. Overall, the management of this patient should focus on reducing morbidity and mortality, improving quality of life, and addressing the underlying causes of the patient's symptoms.