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J Am Acad Dermatol. 2015 Mar;72(3):465-72. doi: 10.1016/j.jaad.2014.12.019. Epub 2015 Jan 13.

Is cardiovascular evaluation necessary prior to and during beta-blocker therapy for infantile hemangiomas?: A cohort study.

Author information

1
Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: m.f.raphael-2@umcutrecht.nl.
2
Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
3
Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
5
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
6
Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pediatric Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
7
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

BACKGROUND:

Although consensus guidelines for pretreatment evaluation and monitoring of propranolol therapy in patients with infantile hemangiomas (IH) have been formulated, little is known about the cardiovascular side effects.

OBJECTIVES:

We sought to analyze cardiovascular evaluations in patients with IH at baseline and during treatment with an oral beta-blocker.

METHODS:

Data from 109 patients with IH were retrospectively analyzed. Patient and family history, pretreatment electrocardiogram (ECG), heart rate, and blood pressure were evaluated before initiation of beta-blocker therapy. Blood pressure and standardized questionnaires addressing side effects were evaluated during treatment.

RESULTS:

Questionnaire analyses (n = 83) identified 3 cases with a family history of cardiovascular disease in first-degree relatives. ECG findings were normal in each case and no serious complication of therapy occurred. ECG abnormalities were found in 6.5% of patients but there were no contraindications to beta-blocker therapy and no major complications. Hypotension in 9 patients did not require therapy adjustment. In all, 88 parents (81%) reported side effects during beta-blocker treatment.

LIMITATIONS:

The relatively small patient cohort is a limitation.

CONCLUSION:

Pretreatment ECG is of limited value for patients with an unremarkable cardiovascular history and a normal heart rate and blood pressure. Hypotension may occur during treatment.

KEYWORDS:

beta-blocker therapy; cardiovascular side effects; infantile hemangioma; treatment evaluation

PMID:
25592625
DOI:
10.1016/j.jaad.2014.12.019
[Indexed for MEDLINE]

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