Beta-Blocker Contraindications Mnemonic – “ABCDE”

Banner Image

Beta-Blocker Contraindications Mnemonic

“Beta-blockers for everyone?”

Banner Image

Well, not quite. Sometimes prescribing them is like handing a sleepy man a sedative — it might look logical until he stops breathing.

During our CCU rounds last week, a 68-year-old gentleman from Tump (Kech district) came in with a slow AF and a BP of 90/60. His nephew had already googled “best medicine for heart rate control” and was asking for propranolol like it was Panadol. 😑

Banner Image

Of course, if you’ve practiced with the likes of Dr. Imran Baloch (Cardiology whisperer) or been grilled by Dr. Basit Khan, you’ll know beta-blockers are great — but not always safe.

🔑 Mnemonic: “ABCDE” — Contraindications to Beta-Blockers

Letter Condition Explanation
A Asthma Non-selective beta-blockers can trigger bronchospasm — wheeze city 🚑
B Heart Block Especially 2nd or 3rd degree — may worsen bradycardia or complete the block 🧱
C COPD (severe) Non-selective ones can worsen airflow limitation — especially in brittle lungs 😮‍💨
D Diabetes Mellitus Can mask hypoglycemia symptoms like tachycardia — diabetic ninja attacks 🥷🍬
E Electrolyte imbalance Especially hyperkalemia — worsens AV nodal suppression, arrhythmia risk ⚡

 

Banner Image

Why knowing beta-blocker contraindications matter?

A few months ago, a retired school principal from Zhob was admitted with bradycardia (HR 42), known COPD, and uncontrolled diabetes. Junior staff had charted carvedilol for borderline hypertension.

The next morning — confusion, low BP, wheezing, and blood sugar of 38. 🤦‍♂️
Cue Dr. Bilal Chaudhary whispering, “Classic beta-blocker train wreck.”

We reversed the bradycardia with atropine, corrected the glucose, called off the beta-blocker, and gave salbutamol. Lesson learned: always screen the ABCDEs before reaching for that metoprolol.

💡 Key Clinical Pearls

  • Use cardioselective beta-blockers (e.g., bisoprolol) in COPD or asthma only if absolutely necessary — and never in acute exacerbations.
  • Always check ECG for heart block before starting — especially in elderly patients or those on other nodal blockers (like diltiazem).
  • Monitor blood glucose in diabetic patients on beta-blockers — hypoglycemia without warning signs is not a fun surprise.
  • Don’t forget the serum K+ — especially in CKD or those on ACE inhibitors/spironolactone. Hyperkalemia + AV nodal suppression = 🎯 for asystole.
  • Be cautious when treating patients from rural areas (like Mashkai or Nokundi) who may have limited follow-up. The safest drug is the one they won’t need emergency resuscitation from.

Authored by:

Dr. Aurangzaib Qambrani
MBBS | PLAB | MRCP (UK)
Sheikh Khalifa Bin Zayed Hospital, Quetta



Banner Image

Source link


Discover more from Bibliobazar Digi Books

Subscribe to get the latest posts sent to your email.

Leave a Comment

Discover more from Bibliobazar Digi Books

Subscribe now to keep reading and get access to the full archive.

Continue reading