Cardiac arrest: Use of beta blockers (ACLS training)

Ahmed Raza

Reviewed by Lorraine Anne Liu, RN, a registered nurse and cum laude graduate with experience in OR, ICU, delivery room, and OPD. She specializes in pediatric care and primary health care nursing and is certified in BLS, IV therapy, and cardiac assessment.

Introduction

Cardiac problems are the major reason for death and account for approximately 30% of all deaths all over the globe (GBD 2015). Heart failure is the most rapidly increasing cardiovascular condition worldwide, causing approximately 382,820 million deaths in 2020 (CDC, 2022). The cases of heart failure in the USA surpass 5.8 million people and more than 550,000 new patients are registered every year. It is calculated that by the year 2030, more than eight million people (one in every 33) will be reported with heart failure in the USA. Similar growing trends have been seen in Asia.¹ The occurrence of shockable rhythm [ventricular tachycardia (VT), ventricular fibrillation (VF) as first registered heart rhythm in out-of-hospital cardiac arrest (OHCA) has shown a certain decrease globally as compared to non-shockable rhythm [pulseless electrical activity (PEA) and asystole] during last years. Different reasons for this reduced incidence have been reported, such as a decrease in the death rate from ischaemic heart disease (IHD), a rise in the use of implantable cardiac defibrillators, and development in cardiac failure management with beta-blockers as the keystone of the medical therapy. The constant use of beta-blockers has increased remarkably during the last years because of their beneficial results on mortality after myocardial infarction and in congestive heart failure (CHF). This development has been proposed as one of the key reasons for the decrease of shockable rhythm in OHCA, evaluating the anti-fibrillatory and anti-arrhythmic effects of these drugs. ²

Numerous studies have reported that beta-blockers have been beneficial to decline sudden cardiac death in heart failure patients, some studies have shown mixed outcomes. Chances of sudden cardiac death(SCD) are decreased upto 31%, and cardiovascular death (CVD) by 29%, and all-cause death rate by 33% by the use of beta blockers. ³

Indications

Beta-blockers, as a class of medicines, are chiefly used for the treatment of cardiovascular diseases and other ailments.

Beta receptors exist in three discrete shapes: beta-1 (B1), beta-2 (B2), and beta-3 (B3). Beta-1 receptors are found mainly in the heart mediate cardiac activity. Beta-2 receptors are located in varied positions of many organ systems control different characteristics of metabolic activity and induce smooth muscle relaxation. Beta-3 receptors affect the breakdown of fat cells and not much clinically connected at present. Beta-blocker medicines are used to treat a wide range of diseases by blocking these receptors. Beta-blockers, as a class of drugs, are crucial medication and are first-line cures in many critical conditions. FDA has approved and specified beta-blockers for the treatment of tachycardia, hypertension, hyperthyroidism, essential tremor, aortic dissection, portal hypertension, glaucoma, migraine prophylaxis, myocardial infarction, congestive heart failure, cardiac arrhythmias, coronary artery disease, hyperthyroidism, and other diseases. They are also in use to administer less familiar ailments such as long QT syndrome and hypertrophic obstructive cardiomyopathy. Beta-blockers are present for treatment in three main shapes: oral, intravenous, and ophthalmic, and the way of administration relies on the acuity of the disease (parenteral use in arrhythmias), illness type, and chronicity of the condition.⁴

Administration of beta-blockers

Beta-blockers are present in oral, intravenous, or ophthalmic forms and are also available as injectable intramuscularly. Dosages are accessible on different scales, depends on the particular medication.⁴

Adverse effects

Beta receptors are located all over the body and affect a wide range of physiologic changes. Beta-blockers drugs blocking these receptors can create many adverse effects. Two unfavorable effects that may usually happen are bradycardia and hypotension. Fatigue, dizziness, nausea, and constipation are also commonly noticed. Some patients revealed sexual dysfunction and erectile dysfunction. Less familiarly, bronchospasm exists in patients using beta-blockers. Asthmatic patients are more vulnerable. Patients with Raynaud syndrome are also in danger of exacerbation. Beta-blockers can affect both hyperglycemia and disguise the hemodynamic indications, commonly found in a hypoglycemic patient, such as tachycardia. Insomnia, sleep changes, and nightmares recorded in some patients while using beta-blockers. This effect is more noticeable with beta-blockers that cross the blood-brain threshold. Carvedilol can rise edema in some patients. ⁴

Summary

Beta-blockers are a wide range of drugs that are used for different clinical advantages but also carry the possibility of side effects. Beta-blockers are advised by physicians and nurse practitioners in both outpatient and inpatient settings, mostly for the treatment of cardiovascular-related diseases. If a patient is admitted to a ward, observing the clinical reactions and possible side effects is an interprofessional duty. Nurses will normally be the first respondents to take note of any unfavorable reactions, such as a change in vital signs. Many clinical trials have been carried out on beta-blockers and proved then to prolong life in patients with cardiovascular illness. The health care team should prescribe, manage, and monitor the use of beta-blockers safely and productively.⁴

References

1. Centers for Disease Control and Prevention. (2022, July 15). Heart disease facts. Centers for Disease Control and Prevention. Retrieved August 9, 2022, from https://www.cdc.gov/heart-disease/data-research/facts-stats/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400473/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716800/
4. https://www.ncbi.nlm.nih.gov/books/NBK532906/