QuestionSBA
QuestionChoice
Stress echocardiography may be indicated following a full specialist assessment but is unlikely to be used to demonstrate effectiveness of treatment with bisoprolol
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d
Stress echocardiogram
QuestionChoice
Her blood pressure is likely to be lowered due to beta blockade and blunting of the sympathetic response, but it is not a useful marker of effective treatment
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b
Blood pressure
QuestionChoice
An increase in exercise tolerance due to a reduction in angina symptoms indicates effective treatment with bisoprolol
34430
a
Exercise tolerance
QuestionChoice
Her heart rate is likely to be lowered due to beta blockade and blunting of the sympathetic response, but it is not a useful marker of effective treatment
34432
c
Heart rate
QuestionChoice
An elevation in cardiac enzymes may suggest some ongoing myocardial ischaemia and can be useful in the general clinical setting on a background of acute chest pain, but is of limited usefulness to determine effectiveness of treatment with bisoprolol
34434
e
Troponin
QuestionComment
in the psa practice papers, it states the best way to assess whether a BB is working is via HR?
17454
QuestionComment
For AF 
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Swtmess
QuestionComment
Agreed re:AF 
+ the way I thought about it was he is in Normal sinus (ignoring AF) he is not tachy. Therefore is not tachy so why would HR help  
19767
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Gastro X-linked
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Lipsyncope
QuestionComment
Where can I find this in the BNF?
39570
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Neoplasia Sclerosis
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

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Beta blocker monitoring
Topic
92
General Practice
6897
Case Presentation: A 56 year old woman with no significant past medical history attends her GP with intermittent chest pain. The pain is central and constricting with no radiation into her jaw or arms. She only has the pain a few times a week and notices that it comes on when she is either climbing stairs or running for the bus. She denies syncope, sweating, shortness of breath or any other symptoms of ill health.


**Investigations**

ECG: Normal sinus rhythm

Her GP decides to make a routine referral to the outpatient cardiology clinic and prescribes bisoprolol fumarate 5mg PO OD.

Question: Select the most appropriate option to assess the beneficial effects of this treatment.
a