High dose neostigmine treatment of malignant sinus tachycardia

Lex W. Schultheis, Jeffrey R. Balser, Hugh Calkins, Shawn Robertson, James L. Weiss, Marc Sussman, R. Scott Stuart

Research output: Contribution to journalArticle


Sinus tachycardia caused by circulating catecholamines in the setting of congestive heart failure may impair systemic perfusion because of decreased diastolic filling time. We report the case of a patient with Wolff-Parkinson- White syndrome with angina and cardiogenic shock who improved dramatically following administration of neostigmine. Cardiac output, blood pressure, and stroke volume increased as heart rate was reduced. A previous attempt at heart rate control, in the same patient, using o low dose β-antagonist, precipitated hemodynamic collapse. The remarkable recovery of our patient suggests that acetylcholinesterase inhibitors may warrant further investigation in patients with severe sinus tachycardia.

Original languageEnglish (US)
Pages (from-to)1369-1372
Number of pages4
JournalPACE - Pacing and Clinical Electrophysiology
Issue number5 I
StatePublished - Jun 9 1997


  • acetylcholinesterase inhibitors
  • cardiogenic shock
  • neostigmine
  • sinus tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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