Congestive heart failure beta-blockers

Bnnch TJ, Mnhlestein JB, Bair TL, Renlnnd DG, Lappe DL, Jensen KR et al. Effect of beta-blocker therapy on mortality rates and future myocardial infarction rates in patients with coronary artery disease but no history of myocardial infarction or congestive heart failure. Am J Cardiol 2005 95(7) 827-31. 

Brophy JM, Joseph L, Rouleau JL. Beta-blockers in congestive heart failure a Bayesian meta-analysis. Ann Intern Med 2001 134(7) 550-60. 

The most common side effects are Raynaud s phenomenon with cold or even cyanotic distal extremities and digits, tiredness or weakness, bradycardia, and sexual impotence. Less common side effects are depression and dysphoria, bronchoconstriction, congestive heart failure, hallucinations, hypotension, vomiting or nausea, diarrhea, insomnia and nightmares, dizziness, and hypoglycemia. When due attention is paid to contraindications and the treatment is carefully monitored, the side effects of beta-blocker treatment are generally mild. 

Patients should be excluded from beta-blocker treatment if they have significant cardiorespiratory diseases (asthma and other pulmonary obstructive diseases, congestive heart failures, angina), insulin-dependent di-... 

Enalapril maleate is an orally active angiotensin converting enzyme (ACE) inhibitor, it lowers peripheral vascular resistance without causing an increase in heart rate. The maleate salt (enalapril) allows better absorption after oral administration. It is an ideal drug for hypertensive patients who are intolerant to beta-blocker therapy. It also shows promise in the treatment of congestive heart failure. Following oral adminishation, enalapril is rapidly absorbed and hydrolysed to... 

Sorrentino MJ. Beta-blockers for congestive heart failure. Compr Ther. 2003 29 210-214. 

Beta blockers -olol Metoprolol, propranolol Antihypertensive (21), antianginal (22), antiarrhythmic (23), congestive heart failure (24)... 

Abbreviations-. BEST, beta-blocker evaluation survival trial CAPRICORN, caiveclilol postinfarct suivival control in left ventricular dysfunction C1B1S II, Cardiac Insufficiency Bisoprolol Study II COMET, Carvedilol or Metoprolol European Trial COPERNICUS, carvedilol prospective randomized cumulative survival HF, heart failure LVEF, left ventricular ejection fraction MDC, metoprolol in dilated cardiomyopathy MERIT-HF, metoprolol controlled-release randomized intervention trial in congestive heart failure fJYHA, New York Heart Association. 

McNamara DM, Holubkov R, Janosko Ket al (2001) Pharmacogenetic interactions between beta-blocker therapy and the angiotensinconverting enzyme deletion polymorphism in patients with congestive heart failure. Circulation 103 1644-1648... 

STEMI (17). This landmark trial revealed that the use of early beta-blocker therapy in STEMI reduces the risks of reinfarction and ventricular fibrillation. However, there was a small increase in frequency of cardiogenic shock in patients randomized to the beta-blocker group. Therefore, beta-blockers should be contraindicated in patients presenting with a cardiogenic shock or decompensated congestive heart failure (CHF). Other relative contraindications to beta-blockers include advanced heart block, bradyarrythmias, and active asthma. Unless these contraindications are present, the (ACC/AHA) guidelines list oral beta-blocker therapy within 24 hours as a class I indication in patients with ACS (18). In patients presenting with left ventricular dysfunction after MI as defined by an ejection fraction <40%, carvedilol has been shown to reduce reinfarction rate and mortality in the Carvedilol Post Infarction Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial when compared with placebo (19). 

Acebutolol is indicated in the management of hypertension and premature ventricular contractions. It is contraindicated in hypersensitivity to beta-blockers persistently sever bradycardia greater than first-degree heart block congestive heart failure, unless secondary to tachyarrhythmia treatable with beta-blockers overt cardiac failure sinus bradycardia cardiogenic shock. The side effects reported for acebutolol include hypotension, bradycardia, CHF, cold extremities, heart block, insomnia, fatigue, dizziness. 

Concomitant use of verapamil with adrenergic-receptor beta blockers may cause additive effects leading to congestive heart failure, conduction disturbances, arrhythmias, and hypotension. 

Are beta-blockers useful in the therapy of congestive heart failure and cardiomyopathy ... 

C. Toxicity Cardiovascular adverse effects, which are extensions of the beta blockade induced by these agents, include bradycardia, atrioventricular blockade, and congestive heart failure. Patients with airway disease may suffer severe asthma attacks. Premonitory symptoms of hypoglycemia from insulin overdosage, eg, tachycardia, tremor, and anxiety, may be masked, and mobilization of glucose from the liver may be impaired. CNS adverse effects include sedation, fatigue, and sleep alterations. Atenolol, nadolol, and several other less lipid-soluble beta-blockers are claimed to have less marked CNS action because they do not enter the CNS as readily as other members of this group. 

B) Congestive heart failure from beta-blockers... 

Congestive heart failure can be precipitated by beta blockers. Choices (A), (C), and (E) reverse the correct pairing of receptor subtype (alpha versus beta) with effect. Choice (D) reverses the direction of change of intraocular pressure. The answer is (B). 

Beta,-selective blocker low lipid solubility, less CNS effect used for HTN. (Names of P,-selective blockers start with A through M except for carteolol, carvedilol, and labetalol.) Tox bradycardia, AV block, congestive heart failure. 

Smith, A.J. Wehner, J.S. Manley, FI.J. Richardson, A.D. Beal, J. Bryant, P.J. Current role of beta-adrenergic blockers in the treatment of chronic congestive heart failure. Am. J. Flealth. Syst. Pharm. 2001, 58, 140-145. 

On the basis of this report, and on reports of studies in animals and from the known risks associated with the concurrent use of beta blockers (see Disopyramide -i- Beta blockers , p.252), the UK manufacturer warns about combining disopyramide and other drugs [such as verapamil] that may have additive negative inotropic effects. However, they do point out that in some specific circumstances combinations of antiarrhythmie drugs (they specifically name digoxin, beta blockers and verapamil for the control of atrial fibrillation) may be beneficial. They note that severe hypotension caused by disopyramide has usually been associated with cardiomyopathy or uncompensated congestive heart failure. However, the US manufacturer advises that until more data is available, disopyramide should not be given within 48 hours before or 24 hours after verapamil. ... 

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