What is the role of beta-blockers in the treatment of acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Beta-blockers are indicated in all patients unless they have the following contraindications:

  • Systolic blood pressure less than 90 mm Hg

  • Cardiogenic shock

  • Severe bradycardia

  • Second- or third-degree heart block

  • Asthma or emphysema that is sensitive to beta agonists

  • Peripheral vascular disease

  • Uncompensated CHF

Beta blockers reduce oxygen demand and ventricular wall tension. They also decrease mortality and adverse cardiovascular events. These drugs may prevent mechanical complications of myocardial infarction, including rupture of the papillary muscle, left ventricular free wall, and ventricular septum. Beta blockers meliorate dynamic obstruction of the left ventricular outflow tract in patients with apical infarct and hyperdynamic basal segments.

The most frequently used regimen is IV metoprolol 2-5 mg given every 5 minutes (up to 15 mg total) followed by 25-100 mg given orally twice a day.

Beta-blockers should not be used acutely in patients with cardiogenic shock or signs of heart failure on presentation.

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