beta blockers and acute MI

[thorg12]

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Im aware of the idea of beta blockers reducing mortality after MI but
if my memory serves me correctly werent there papers recently
disputing this saying that they are dangerous in the setting of acute
MI? If someone could point me in the direction of that paper I would
really appreciate it. Thanks a lot.

 

[Jeff698]

I'm not aware of any papers showing a reduction in mortality.

Early on in the study of MI, back before we even gave aspirin, lots of patients would have VT while in the hospital. Beta blockers would reduce these arrhythmias.

I often thought of the concept behind beta blockers as decreasing workload. Apparently, this wasn't the case. They were being used as an anti-arrhythmic.

There have been some suggestions recently that the use of beta blockers in patients who later develop cardiogenic shock is linked to increased mortality but I do not believe causality was conclusively shown. The big problem, of course, is we don't necessarily know who will develop cardiogenic shock in the next several days when we give BBs up front.

So... potential risk, no real gain. Probably shouldn't be doing it blindly for everyone with chest pain. This seems to have changed only recently in my experience. Even in my last year of residency (I'm starting my second year out now) we would give lopressor to everyone. I gave it for the first time in over a year (in this context) last shift but only because of specific indications (hyperdynamic, hypertensive with dynamic ST changes).

Sorry I can't serve up the specific references, I'm about to head to work. You'll have to consider this anecdotal information.

Take care,
Jeff

 

[GiJoe]

commit trial

 

[southerndoc]

The data supporting beta blockers in MI patients is mainly based on patients who received thrombolytics. Data from patients receiving PCI show more cardiogenic shock, but no worse mortality.

This is the reason the Joint Commission no longer considers it a core measure to give beta blockers upon arrival to the hospital in acute MI patients, but it's still a core measure upon discharge from the hospital.

 

[shortbread9]

There is a study out there and forgive me for forgetting the name but it does show increase mortality from IV beta blockers. We do use bb's but orally as long as the patient has a HR >60 and is not hypotensive. im assuming this is why you heard that bb are now bad...but its actually just the iv form for some reason that shows increase mortality in the longer term...not even acutely! either way we just stick to PO.
and you can use the iv form for arrythmias such as afibb with rvr...the above is just in rule out mi.