Which of the following would be an indication for discontinuing metoprolol in this patient? A 55-year-old man is admitted to the hospital with UA. He was given aspirin, morphine, sublingual nitroglycerin, and metoprolol in the emergency department. When the patient arrives to the fl oor, the nurse pages you with an abnormal ECG. The ECG shows a sinus rhythm at 68 beats per minutes and a fi rst-degree atrioventricular (AV) block. The nurse asks if you would like to hold the patients next dose of metoprolol.
A. First-degree AV block B. Heart rate less than 70 beats/min C. Asthma D. Peripheral vascular disease
Asthma-key concept/objective: to recognize the contraindications for beta blocker therapy in acute coronary syndromes beta blockers should be administered as adjunct therapy in acute mi as they reduce heart rate, lower blood pressure, reduce cardiac contractility, and reduce myocardial oxygen demand. beta blockers reduce myocardial infarct size, alleviate the pain of acute mi, and reduce the likelihood of developing complications of acute mi. beta blockers also reduce mortality from acute mi. beta blockers remain underused in clinical practice despite the data demonstrating effi cacy from their use in acute mi. beta blockers should be given to all patients with acute mi unless there is a strong contraindication to treatment. contraindications to treatment with a beta blocker include asthma, known allergy, the presence of high-grade av block at the time of presentation, cardiogenic shock, hypotension or severe pulmonary edema, and heart rate less than 50 beats/min at the time of evaluation. the presence of mild to moderate heart failure, known obstructive airway disease (in the absence of asthma), known peripheral vascular disease, diabetes mellitus, and a history of cardiomyopathy are not contraindications to treatment with beta blockers.