Changes in the Cardiovascular System during Therapy with Propranolol of Infantile Hemangiomas

Background: Propranololol is undeniably effective as an infantile hemangiomas (IH) treatment, however, the drug acts on the myocardial tissue and heart rate.

Objective: To assess the state of the cardiovascular system in patients before treatment, during therapy with propranolol and after its completion.

Methods: Cardiac examination (ECG, echocardiogram, 24-Hour Holter monitoring), and ultrasound with Doppler of IH vessels were performed 202 children aged 1 month to 4.5 years with IH different localization. Studies were conducted before the appointment of propranolol therapy, then every 3 months during treatment and after discontinuation of therapy.

Results: According to the ECG, there was not a single case of bradycardia. However, 24-Hour Holter monitoring showed that in all children, 3 months after the start of therapy, the average daily heart rate decreased by 9% from the norm. Also, according to 24-Hour Holter monitoring, 18% of children were diagnosed with AV-blockade of grade I-II and 6% of children were diagnosed the rhythm pauses, significantly exceeding the age norm. Syncopal states were observed in 2 children, accompanied by pauses of the heart rhythm with a maximum duration of 18 seconds. In 1 child, according to the echocardiogram, there was a decrease in the contractile function of the myocardium. Doppler ultrasound found that when blood flow in the vessels was

Conclusion: Cardiological examination revealed a small percentage of undesirable effects on the background of propranol. Only a flow-up 24-Hour Holter monitoring allowed timely identification of life-threatening changes in heart rate and timely correction of the dose of the drug. Ultrasound with Doppler allowed us to establish an individual duration of treatment with propranolol and to minimize the percentage of rebound syndrome against the background of discontinuation of therapy with propranolol.