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Propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and the velocity and extent of myocardial contraction. Propranolol is a competitive antagonist which specifically competes with beta-adrenergic receptor stimulating agents for available beta-receptor sites. You have ischemic heart disease. Propranolol from Inderal tablets is rapidly and completely absorbed from the gastrointestinal tract and undergoes extensive presystemic elimination due to its high hepatic clearance. The elevated outflow pressure gradient which is exacerbated by beta-adrenergic receptor stimulation. Treatment must always be initiated and individual titration of dosage carried out using the conventional tablets. Propranolol exerts ant arrhythmic effects in concentrations producing beta-adrenergic blockade, which appears to be its principal ant arrhythmic mechanism of action. Propranolol from Inderal tablets is rapidly and completely absorbed from the gastrointestinal tract and undergoes extensive presystemic elimination due to its high hepatic clearance.