Acute myocardial infarction: Role of beta blocker therapy
- Robert S Rosenson, MD
Robert S Rosenson, MD
- Section Editor — Lipids
- Professor of Medicine
- Mount Sinai School of Medicine
- Director, Cardiometabolic Disorders
- Mount Sinai Heart
- Guy S Reeder, MD
Guy S Reeder, MD
- Section Editor — Coronary Disease
- Professor of Medicine
- Mayo Medical School
- Harold L Kennedy, MD, MPH
Harold L Kennedy, MD, MPH
- Adjunctive Professor of Medicine and Cardiovascular Diseases
- University of Missouri School of Medicine
For patients with acute myocardial infarction (MI), beta blocker therapy reduces infarct size and early mortality when started early and lowers the risk of death when continued long term. The evidence supporting the benefit of beta blockers has been obtained primarily from randomized trials that included predominantly patients with ST-elevation MI (STEMI). There have been no randomized trials specifically addressing the efficacy of these drugs in non-ST elevation MI (NSTEMI); however, there is no observational evidence to suggest different outcomes in patients with NSTEMI. (See "Overview of the acute management of ST elevation myocardial infarction" and "Overview of the acute management of unstable angina and non-ST elevation myocardial infarction" and "Prevention of cardiovascular disease events in those with established disease or at high risk".)
This topic will discuss the use of beta blockers in patients with acute MI. Other relevant issues regarding beta blockers are discussed elsewhere. (See "Major side effects of beta blockers" and "Use of beta blockers in heart failure with reduced ejection fraction" and "Prophylaxis against ventricular arrhythmias during and after acute myocardial infarction" and "Clinical features and treatment of ventricular arrhythmias during acute myocardial infarction".)
MECHANISM OF ACTION
Potentially beneficial effects of beta blockers in patients with acute myocardial infarction (MI) include :
●Decreased oxygen demand due to the reductions in heart rate, blood pressure, and contractility, and the consequent relief of ischemic chest pain.
●Decreased risk of ventricular fibrillation as suggested by experimental studies demonstrating an increase in the ventricular fibrillation threshold and by clinical trials showing a relative risk reduction in sudden cardiac death (eg, 30 to 47 percent) [2-4].
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- MECHANISM OF ACTION
- No reperfusion
- Fibrinolytic therapy
- Primary PCI
- INITIAL THERAPY
- Fibrinolytic therapy
- Primary PCI
- Choice of drug
- Patients with hypertension
- LONG-TERM THERAPY
- Heart rate goal
- Absolute contraindications
- Patients with comorbidities
- - COPD/asthma
- - LV dysfunction/heart failure
- - Diabetes mellitus
- - Peripheral artery disease
- - Patients treated with antiarrhythmic drugs
- RECOMMENDATIONS OF OTHERS
- SUMMARY AND RECOMMENDATIONS