Do Beta Blockers cause coronary vasoconstriction?

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mariambaby3

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Since there are Beta 2 receptors on the heart, do non-selective BBs also cause vasoconstriction in the coronary arteries (in addition to peripheral arteries)?

But overall, we give still give them to patients with poor cardiac function because the Beta 1 blockade has an overall effect of reducing myocardium O2 demand more than the reduction in O2 supply from the Beta 2 blockade?

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First of all, the control of vascular tone is mainly by the action of alpha 1 receptors which are innervated, these are the main effectors of the sympathetic nervous system adrenergic effects. Beta 2 receptors in vascular smooth muscle are not innervated and basically will only cause vasodilation by stimulation from circulating epinephrine produced in the adrenal medulla(neuro-humoral). If you directly(direct agonist) stimulate B2 receptors you will get vasodilation but they are not used for this reason, thats actually an adverse effect of these bronchodilators. Having said that, Blocking beta2 receptors is not directly producing the opposite effect, they are not in charged of vasoconstriction, in some cases, Non- selective beta blockers are actually used in cases of hypertension. Blocking B2 doesn't mean you are stimulating alpha1 receptors who are the ones in charge of vasoconstriction; only in patients with vasospastic pathologies like Reynaud's you would see maybe an exacerbation or possibly as a reaction to prolonged decrease of cardiac output.
The main action in the heart is by blocking B1 receptors, when you decrease contractility you decrease demands of O2, you are also decreasing heart rate and that has a direct effect increasing diastolic interval which is the time when blood flows from the coronary arteries to the cardiac muscle so you are actually INCREASING perfusion to the heart. Also by blocking B receptors you are decreasing the sympathetic outflow stimulation in 2 ways: in the CNS you are decreasing the release of neurotransmitters and in the kidneys by blocking B1 you are inhibiting the production of renin thus decreasing the RAAS.....
I hope that explains to you why beta blockers don't cause coronary vasospasm and they don't reduce de O2 supply to the heart. 😉
 
Forgot to mention.... the important adverse effects when administering this kind of drug is bronchospasm.... exacerbation of Asthma attacks (totally contraindicated in Asthma patients), Severe Hypoglycemia in type 1 Diabetics and hyperlipidemia.
 
In any case, coronary blood flow is not (directly) regulated by the sympathetic nervous system. The dilation/constriction of the coronary arteries is a result of metabolic regulation (local control of blood flow exerted through a direct action of local metabolites on vascular smooth muscle tone). So for example if you gave an alpha-1 agonist you would not see constriction of the coronaries, but you would see constriction of ateriolar smooth muscle in the periphery.
 
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Forgot to mention.... the important adverse effects when administering this kind of drug is bronchospasm.... exacerbation of Asthma attacks (totally contraindicated in Asthma patients), Severe Hypoglycemia in type 1 Diabetics and hyperlipidemia.

Use Beta blockers with caution in asthma but they are not absolutely contraindicated in asthma.
 
Use Beta blockers with caution in asthma but they are not absolutely contraindicated in asthma.

Correct, but just wanted to clarify your point. You want to avoid nonselective beta blockers, which would cause problems with asthma.

The lungs are have beta 2 receptors, a nonselective beta blocker would block beta 1 and beta 2, which would cause bronchoconstriction.

A selective beta blocker would just block beta 1 receptors, so no problems with bronchoconstriction.

Selective beta blockers start with A-M, not including L and C, while nonselective beta blockers are N-Z, including L and C...and end in lol.
 
Since there are Beta 2 receptors on the heart, do non-selective BBs also cause vasoconstriction in the coronary arteries (in addition to peripheral arteries)?

But overall, we give still give them to patients with poor cardiac function because the Beta 1 blockade has an overall effect of reducing myocardium O2 demand more than the reduction in O2 supply from the Beta 2 blockade?

coronary arteries like brain circulation are under strict autoregulation(they are so important so they dont let anything else to decide for them) so b2 blockers or agonists will not take an effect
 
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