Ragavendra R. Baliga, M.D
Assistant Professor
Division of Cardiology
University Of Michigan

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Question 28 of 39:

Beta-blockers are contra-indicated in this patient because he has a 12-pack year history of smoking.

You clicked 'True'

Incorrect!

A smoking history by itself is not a contraindication for beta-blocker therapy. The relative contraindications to beta blockers are:

• A asthma
• B bradycardia, AV block including PR interval >0.24 sec, BP<100 mm Hg
• C COPD, cardiac failure (moderate to severe LV failure)
• D Diabetes (IDDM)
• P Peripheral vascular disease

Although relative contraindications once may have been thought to preclude the use of ß-blockers in some patients, new evidence suggests that the benefits of ß-blockers in reducing reinfarctions and mortality may actually outweigh the risks, even in patients with asthma; insulin-dependent diabetes mellitus; chronic obstructive pulmonary disease; severe peripheral vascular disease; PR interval >0.24 sec; and moderate LV failure. Use of ß-blockers in such patients requires careful monitoring of patient to be certain that adverse events do not occur [1-3].

Reference:

1. Gottlieb SS, McCarter RJ, Vogel SA. Effects of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998;280:623-629.

2. Soumerai SB, McLaughlin TJ, Spiegelman D et al. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA 1997;277:115-121.

3. Marciniak TA, Ellerbeck EF, Radford MJ et al. Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project. JAMA 1998;280:623-629.