From the Guidelines
The most concerning medical history for a patient being considered for propranolol treatment for recurrent ventricular tachycardia would be asthma. Propranolol is a non-selective beta-blocker that blocks both beta-1 receptors (primarily in the heart) and beta-2 receptors (primarily in the lungs) 1. When beta-2 receptors in the bronchial smooth muscle are blocked, this can cause bronchoconstriction and potentially trigger severe bronchospasm in patients with asthma. This reaction can be life-threatening, especially in patients with a history of asthma or other reactive airway diseases. While propranolol is effective for treating various cardiac conditions including ventricular tachycardia, its use in asthmatic patients poses a significant risk that generally outweighs its benefits. The other conditions mentioned—exercise-induced tachyarrhythmias, hypertension, and paroxysmal atrial tachycardia associated with emotion—are not contraindications for propranolol; in fact, propranolol may be beneficial in managing these conditions as it reduces heart rate and blood pressure through its beta-blocking effects 1. Some key points to consider when prescribing propranolol for ventricular tachycardia include:
- The patient's medical history, particularly any history of asthma or reactive airway disease
- The potential benefits of propranolol in reducing the risk of recurrent ventricular tachycardia
- The potential risks of propranolol, including bronchoconstriction and exacerbation of asthma symptoms
- Alternative treatment options, such as catheter ablation or other medications, that may be available for patients with contraindications to propranolol 1.
From the FDA Drug Label
Nonallergic Bronchospasm (e.g., Chronic Bronchitis, Emphysema): In general, patients with bronchospastic lung disease should not receive beta-blockers. Propranolol should be administered with caution in this setting since it may provoke a bronchial asthmatic attack by blocking bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta-receptors The patient’s medical history of Asthma will be of greatest concern to the prescriber when ordering propranolol for a patient with recurrent ventricular tachycardia, as propranolol may provoke a bronchial asthmatic attack by blocking bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta-receptors 2.
From the Research
Patient Medical History Concerns
When considering ordering propranolol for a patient with recurrent ventricular tachycardia, the prescriber will be most concerned about the following information in the patient's medical history:
- Asthma: This is because propranolol is a non-selective beta-blocker, and its use in patients with asthma can worsen asthma symptoms 3, 4.
Relevant Conditions
Other conditions that may be relevant to the prescriber's decision include:
- Exercise-induced tachyarrhythmias: While this condition may be related to the patient's ventricular tachycardia, it is not directly relevant to the use of propranolol.
- Hypertension: Propranolol can be used to treat hypertension, but its use in patients with asthma requires caution 5.
- Paroxysmal atrial tachycardia associated with emotion: This condition is not directly relevant to the use of propranolol for ventricular tachycardia.
Beta-Blocker Use in Asthma
The use of beta-blockers, including propranolol, in patients with asthma is a concern due to the potential for worsening asthma symptoms 3, 4. However, cardioselective beta-blockers may be used in patients with non-severe asthma and a history of heart failure or myocardial infarction, when benefits outweigh risks 5.
Propranolol for Ventricular Tachycardia
Propranolol may be effective in treating ventricular tachycardia, and its use has been associated with improved outcomes in patients with refractory ventricular fibrillation or pulseless ventricular tachycardia 6.