Clinical experiences with propranolol

Abstract

Propranolol has been used in the treatment of a variety of conditions in 54 patients. It was found to be of value in the reversion of supraventricular and ventricular tachycardia to sinus rhythm, but proved disappointing when given as prophylactic therapy to patients with paroxysmal arrhythmias. Similarly it proved ineffectual as a prophylactic drug to maintain sinus rhythm after DC shock reversion of atrial fibrillation. Propranolol was effective in slowing the heart rate in both sinus tachycardia and atrial fibrillation and proved of benefit in patients with "effort syndrome." In angina pectoris in a small uncontrolled series, results did not suggest that propranolol was of value. In a further 50 patients given propranolol during anesthesia it was found to be of value in abolishing ventricular arrhythmias and in slowing the heart rate in certain circumstances. The dangers of propranolol are immediate hypotensive reactions following parenteral use, notably in shocked subjects, and delayed hypotensive responses when used as long-term oral therapy, especially in patients with ischaemic heart disease. Heart failure may theoretically be aggravated by the drug and bronchospasm has been observed in asthmatic and bronchitic subjects under treatment. Addendum.-Since this paper was written, propranolol has been used with apparent benefit in the following situation: a patient developed ventricular fibrillation associated with an acute coronary occlusion and was successfully reverted to sinus rhythm using internal DC defibrillation. However return of ventricular fibrillation occurred twice in the following twenty minutes requiring further DC shock. Intravenous propranolol (2 mg.) was then administered and sinus rhythm was maintained and the patient survived.