Propranolol is contra-indicated in a patient of angina pectoris, when he is already receiving:
**Core Concept**
Propranolol is a non-selective beta-blocker that can worsen heart failure and decrease the heart rate, which may exacerbate symptoms of angina pectoris. In patients with angina, the goal is to increase the heart rate and contractility to improve cardiac output and reduce ischemia.
**Why the Correct Answer is Right**
In a patient with angina pectoris, the use of propranolol can further decrease the heart rate and contractility, leading to decreased cardiac output and increased ischemia. This is particularly concerning when combined with other medications that can also decrease cardiac output, such as nitrates. The combination of propranolol and nitrates can lead to severe hypotension, decreased cardiac output, and worsening of angina symptoms.
**Why Each Wrong Option is Incorrect**
* **Option A:** Nitrates are actually used to treat angina pectoris and are not contraindicated with propranolol.
* **Option B:** Digitalis is used to increase the contractility of the heart and is not contraindicated with propranolol.
* **Option C:** Amlodipine is a calcium channel blocker that can actually be used in conjunction with propranolol to treat angina pectoris.
**Clinical Pearl / High-Yield Fact**
It's essential to remember that beta-blockers like propranolol can worsen heart failure and decrease cardiac output, making them contraindicated in patients with angina pectoris who are already receiving medications that can decrease cardiac output.
**Correct Answer:** D. Verapamil