Massive pulmonary embolism causing large T-wave inversion and QT prolongation.

We present a case of massive pulmonary embolism where the electrocardiogram (ECG) demonstrated transient T-wave inversion and marked QT-prolongation. The pathomechanism and clinical significance of these changes are discussed.

Switching beta-blocker therapy in chronic heart failure.

Background: A beneficial effect on survival has been proven for the four long-acting beta-blockers. Such favorable results could not be obtained with short-acting beta-blockers.

Aims: to study the safety of switching from short-acting metoprolol to long-acting bisoprolol in patients with cardiac failure and postinfarction impaired left ventricular systolic function.

Bradycardia can induce increased serum natriuretic peptide-level.

Here we report a case of an elderly woman whose antihypertensive beta-blocker therapy induced sinus arrest with a 40 bpm junctional escape rhythm. Although there was no sign of heart failure during bradycardia, a highly elevated amino-terminal pro-brain natriuretic peptide (NT-proBNP) serum level was detected. Cessation of the beta-blocker agent resulted in normal sinus rhythm and a rapid fall in the NT-proBNP serum level.