Propranolol has two separate and distinct effects. The first is a consequence of the drug's ß-blocking properties and the subsequent removal of adrenergic influences on the heart. The second is associated with its direct myo-cardial effects (membrane stabilization). The latter action, especially at high clinically employed doses, may account for its effectiveness against arrhythmias in which enhanced ß-receptor stimulation does not play a significant role in the genesis of the rhythm disturbance.
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