A patient with dilated cardiomyopathy and portal HTN: which
Beta-blockers (BB) are group of drugs which are used for a variety of indications in medicine, starting from cardiac arrhythmia to chronic liver disease and glaucoma. There are various types of BB and the different diseases require different types. However, sometimes, the same patient may have two or more of these diseases simultaneously and then, the choice of a single beta blocker becomes a contentious issue.

Published in the Journal of the Association of Physicians of India, the authors describe cases where the same patient had two diseases, both of which necessitated the use of beta blockers, albeit of different classes.

Two male patients presenting with gradually progressive dyspnoea. Both of them were alcoholic for the last eight to ten years. On examination, they were found to have massive ascites with raised jugular venous pressure. Both of them had orthopnoea and bi-basal fine crepitations in both lungs.

Ultrasonography of abdomen revealed shrunken liver and dilated portal vein; upper GI endoscopy revealed grade II-III varices in the esophagus. After initial stabilization, echocardiography was done for both patients. It revealed dilated cardiomyopathy with ejection fractions of 28% and 35% respectively.

In absence of other aetiologies, the cardiomyopathy was assumed to be due to prolonged alcohol exposure (serum iron profiles were done to rule out hemochromatosis). Since both the patients needed beta blockers for cardiac and hepatic pathologies, the respective super-specialty departments were consulted.

Finally, they were started on carvedilol orally at 3.125 mg/day with gradual increase to 12.5 mg/day over one month. At 6 months’ follow up, symptomatically the patients were better and there was no progression of the varices.

Read more here: http://www.japi.org/september_2017/25_correspondence_a_patient_with_dilated_cardiomyopathy_and_portal.html
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