beta blockers for acute decompensated HF

[MudPhud20XX]

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So FA says beta blockers are used for HF except for acute decompensated HF. Can anyone explain this please?

 

[walakin25]

decompensated means clinically unstable, these people are only alive because of their sympathetic drive, if you Block that, its game over

 

[DrPicard]

In HF you want to give beta blockers because they're both anti-ischemic (decrease HR and contractility) and anti-arrhythmic (actions on the AV node).

Decompensated HF is when the patient has become fluid overloaded because the heart cant pump out all the blood is receives due to any cause (infection, arrhythmia, ischemia etc). In such a situation you want to withhold beta blockers, because these drugs function to decrease heart rate and contractility ie they decrease forward flow. This means more accumulation of fluid behind the heart (pulmonary, peripheral edema) which is obviously something you don't want. So you want to stabilize the patient first by fixing his fluid overload, then resume the beta blockers.

 

[Instatewaiter]

In chronic HF, beta blockers blunt the catecholeminergic surge which is cardioprotective in the long run. It does also blunt cardiac output, heart rate and contractility but with chronic HF you tend to have reserve.

Decompensated heart failure includes both volume overload and low output. In both circumstances by blunting the heart rate and contractility you can cause even worse problems. With volume overload, by blunting it, you worsen your output and you get even more pulmonary edema and RH failure. If you are already on them with volume overload often you can continue them. Stopping them or cutting them in half often makes your job easier though. With low output, the BB would blunt contractility and push you truly into cardiogenic shock.