Lopressor and the STEMI

[MJD1521]

I was always curious as to why my local SOP for STEMI and probable AMI never included usage of Lopressor/Metoprolol to reduce myocardial oxygen demand. So, I decided to do a little bit of research and figured I would share with the community at large for others who were wondering:

http://cardiology.jwatch.org/cgi/content/full/2005/1216/1

 

[usalsfyre]

Our protocol for STEMI no longer includes routine beta-blockade for this reason. If the heart rate/BP falls outside set parameters we will administer up to 15mgs (5mgs/5mins) until the HR and BP fall within the target zone. Otherwise it's withheld.

 

[Flight-LP]

I highly doubt this study has any bearing on why you have never utilized this life saving intervention. New Jersey has never been on the cutting edge of progressive EMS sorry to say.

The best treatment for cardiogenic shock is to prevent it from reaching beyond the compensatory stage. Maintaining normotension through volume infusions, vasopressive and inotropic agents, and normothermia can all be done pre-hospital. If that doesn't work, LVAD or IABP placement may be a needed bridge.

Regardless, an interesting aspect of this study is the admission that the increased risk of cardiogenic shock was inclusive of a partial popuation that has a known contraindication to beta-blockers. Naturally that will have a higher incidence of negative outcomes. All this study tells me is that beta-blockers do as they were intended to and kills those who shouldn't take them in the first place.

 

[boingo]

What Flight said.