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Can Lasix And Propanol Be Stopped Abruptly After A Chronic Cardiac Failure?
Question: Suppose a patient has chronic cardiac failure (with a permanent pacemaker, and a tissue aeortic valve replacement).
(1) If the patient is on Lasix and propanol but develops a fluid overload then is it fine to (abruptly (immedicately) cease the administration of propanol and increase the dosage of Lasix? Why?
(2) Would doing this make any difference if the patient also has a 6 cm fusiform abdominal aortic aneurysm?
(3) Would doing this make any difference if the patient also has severe global systolic dysfunction, severe mitral regurgitation, severe triscupid regurgitation, and severe pulmonary hypertension?
Could these questions pleased be answered separately?
(1) If the patient is on Lasix and propanol but develops a fluid overload then is it fine to (abruptly (immedicately) cease the administration of propanol and increase the dosage of Lasix? Why?
(2) Would doing this make any difference if the patient also has a 6 cm fusiform abdominal aortic aneurysm?
(3) Would doing this make any difference if the patient also has severe global systolic dysfunction, severe mitral regurgitation, severe triscupid regurgitation, and severe pulmonary hypertension?
Could these questions pleased be answered separately?
Brief Answer:
No for all three
Detailed Answer:
1. If a patient is on long term beta blocker, unless heart rate or BP is too low or there is ecg evidence of AV block we do not recommend abrupt cession of beta blockers. Of course there can be room for dose reduction. Also why is he on propranolol as we have much better and selective beta blockers for heart failure?
2. No these changes may not make any difference in short term. But in long term a beta blocker is known to reduce the progression and chance of rupture of the aneurysm
3. Yes these changes can make patient feel better at least temporarily but increase in heart rate can have its own adverse events.
But the decision to continue or stop betablocker in patient with decompensated heart failure is very critical decision and should be best taken by the treating physician who is seeing patient regularly.
No for all three
Detailed Answer:
1. If a patient is on long term beta blocker, unless heart rate or BP is too low or there is ecg evidence of AV block we do not recommend abrupt cession of beta blockers. Of course there can be room for dose reduction. Also why is he on propranolol as we have much better and selective beta blockers for heart failure?
2. No these changes may not make any difference in short term. But in long term a beta blocker is known to reduce the progression and chance of rupture of the aneurysm
3. Yes these changes can make patient feel better at least temporarily but increase in heart rate can have its own adverse events.
But the decision to continue or stop betablocker in patient with decompensated heart failure is very critical decision and should be best taken by the treating physician who is seeing patient regularly.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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