Choose a cardioselective oral beta blocker, such as metoprolol or atenolol. Start beta-blocker treatment in all patients within 24 hours if there are no contraindications.
PO Beta-blockers (Preferred)
| Metoprolol tartrate 25 to 50 mg PO every 6 to 12 hours or Atenolol 25 to 50 mg PO twice daily |
Titrate as needed for a goal HR < 70 bpm and SBP > 90
In the acute setting, start with short-acting beta-blockers to allow for more rapid adjustment of dose based on the patient’s blood pressure and heart rate response. Near the time of discharge, switch to longer-acting beta blockers. E.g. Metoprolol Succinate
IV Beta-blockers
In the rare cases when IV beta-blockers are needed e.g. in a patient with ongoing ischemia prior to PCI in whom there is no hemodynamic instability including heart failure, use the following IV beta-blockers:
| Metoprolol tartrate 5mg IV over 2 minutes. May repeat dose every 5 minutes x 3 doses (for a total of 15 mg)
If the patient tolerates the IV metoprolol regimen, start oral treatment with either metoprolol succinate 50 mg PO daily or metoprolol tartrate 25 mg PO 2 to 4 times daily beginning 15 to 30 min after the last IV dose. |
Watch for Bradycardia and hypotension
Long-term therapy: Shoot for goal heart rate below 70 beats per minute while maintaining a systolic pressure above 90 mmHg.