A 75 years old Female diagnosed with PSVT, 15 years back. She was started on calcium channel blocker at the time of diagnosis. Verapamil 20 mg twice. Paroxysm not in controlled. Dose-escalated to 80 mg twice daily. 1 year back routine check-up up revealed bradycardia. The verapamil dose reduced to 80 mg in the morning and 40 mg at night. Pulse rate stabilised followed by bradycardia after 2 months. Verapamil dose revised 40 mg twice daily. Now she is on 40 mg once per day. Her pulse reads 65 to 70 bpm.
No change in rhythm. Following are some question related to this case: 1. What is the cause of reduced tolerance in the span of one year? 2. What is the prognosis? 3 Is the Trial with beta blockers justified? 4. Should she continue with the same molecule? 5. What should be the treatment modality with further intolerance ?
