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Beta blockers in the management of stable ischemic heart disease

Authors
Joseph P Kannam, MD
Julian M Aroesty, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Section Editor
Freek Verheugt, MD, FACC, FESC
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Beta blockers are first-line therapy in the control of symptoms in patients with chronic stable angina, particularly effort-induced angina.

The major issues regarding the use of beta blockers in the medical management of the patient with stable angina and the evidence that these drugs are effective will be reviewed here. Their role, compared with other drugs, in the overall management of angina is discussed separately. (See "Stable ischemic heart disease: Overview of care".)

MECHANISM OF ACTION

The physiologic effects of catecholamines (norepinephrine and epinephrine) are mediated by activation of specific alpha and beta adrenergic receptors. There are at least three distinct types of beta receptors [1-3]:

Beta-1, which are found primarily in heart muscle. Activation of these receptors results in increases in heart rate, contractility, and atrioventricular (AV) conduction, and a decrease in AV node refractoriness.

Beta-2, which are present in heart muscle but are more prominent in bronchial and peripheral vascular smooth muscle. Activation of these receptors results in vasodilatation and bronchodilatation.

                   

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Literature review current through: Aug 2016. | This topic last updated: Sep 21, 2016.
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