Which medications in the drug class Beta-adrenergic blockers are used in the treatment of Acute Coronary Syndrome?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Beta-adrenergic blockers

Beta blockers have antiarrhythmic and antihypertensive properties, as well as the ability to reduce ischemia. They minimize the imbalance between myocardial supply and demand by reducing afterload and wall stress. In patients with acute MI, they decrease infarct size as well as short- and long-term mortality, which is a function of their anti-ischemic and antiarrhythmic properties. These drugs may prevent mechanical complications of myocardial infarction, including rupture of the papillary muscle, left ventricular free wall, and ventricular septum. Beta blockers ameliorate dynamic obstruction of the left ventricular outflow tract in patients with apical infarct and hyperdynamic basal segments. They should not be used acutely in patients with cardiogenic shock or signs of heart failure on presentation.

Metoprolol (Lopressor)

Metoprolol (Lopressor) is a selective beta1-adrenergic receptor blocker that decreases the automaticity of contractions. During IV administration, blood pressure, heart rate, and ECG should be carefully monitored. The goal of treatment is to reduce the patient's heart rate to 60-90 beats/min.

Esmolol (Brevibloc)

Esmolol (Brevibloc) is an excellent drug for use in patients at risk for complications from beta blockers, particularly reactive airway disease, mild to moderate LV dysfunction, and peripheral vascular disease. Its short half-life of 8 min allows for titration to desired effect with the ability to stop quickly prn.

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