A 66-year-old man was admitted for
congestive heart failure with tachycardiac
atrial fibrillation (AF).
Heart failure was improved by
diuretics, but control of heart rate by
verapamil was insufficient, and
bisoprolol was prescribed. After taking 2.5 mg of
bisoprolol, he developed a general malaise followed by sinus
bradycardia and
shock. In addition to
catecholamines, the patient was treated with
intra-aortic balloon pumping and a pacemaker. With intensive
therapy, the general condition was improved, and acute elevation of liver
enzymes after
bisoprolol was normalized by the 17th hospital day. The blood sample taken 30 h after the intake of
bisoprolol showed abnormally high levels. Although the patient was
CYP2D6*10 heterozygote, the precise mechanism for excess accumulation of
bisoprolol and refractory
shock remains unknown. <Learning objective:
Bisoprolol has been used for
heart failure, but it may need caution to avoid hemodynamic deterioration. In our case, refractory
shock and acute liver injury were induced by
bisoprolol. The blood concentration was excessively high. The patient was
CYP2D6*10 heterozygote, but the precise mechanism and
shock are to be studied.>.