The Use of Beta-Blockers for Acute Myocardial Infarction

Page by: E.J. Mayeaux, Jr., M.D.
Louisiana State University Medical Center Shreveport, Louisiana

Contraindications

• Bradycardia of < 50 beats/min
• Significant first-degree atrioventricular block (pulse rate > 240 ms)
• Systolic blood pressure of less than 90 mm Hg
• High-degree atrioventricular block
• Acute congestive heart failure
• Severe asthma

Recommended IV Dosage of Beta-Blockers for Patients with Acute Myocardial Infarction on Admission

• Propranolol 0.1 mg/kg (IV) divided into three equal doses given at 5-minute intervals
• Metoprolol (Lopressor) three 5 mg (IV)doses given at 2-minute intervals. If 15mg tolerated, start 50mg PO dose 15 minutes after IV dose finished.
• Esmolol (Breviblock) Loading dose: 0.5 mg/kg/min for 1 minute followed by a maintenance infusion of 50 ug/kg/min.
• • If an inadequate therapeutic effect is observed, the loading dose should be repeated over 1 minute followed by an increased maintenance dose and orally administered beta-blockers without intrinsic sympathomimetic activity (e.g., atenolol, metoprolol, propranolol, or timolol) are then used 30 to 60 minutes after the intravenous dose. (See PDR for additional titration information.)

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