Skip Navigation

European Heart Journal 1987 8(8):845-854;
Copyright © 1987 by the European Society of Cardiology.
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by MURRAY, D. P.
Right arrow Articles by LITTLER, W. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by MURRAY, D. P.
Right arrow Articles by LITTLER, W. A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© 1987 The European Society of Cardiology

Beta-adrenergic blockade in acute myocardial infarction: a haemodynamic and radionuclide study

D. P. MURRAY, R. G. MURRAY, E. RAFIQI and W. A. LITTLER

Department of Cardiovascular Medicine, University of Birmingham, East Birmingham Hospital Birmingham, U.K.

Received 26 September 1986; revised 30 January 1987; .

Donal Murray, Department of Medicine, Cork Regional Hospital, Cork, Ireland.

While long term beta-adrenergic blockade, introduced in the convalescent stage of myocardial infarction, may reduce subsequent mortality, the value of early beta-blockade in the acute phase is less certain. Therefore, the influence of beta-blockade on left ventricular performance and eventual infarct size was assessed in 61 consecutive patients with acute myocardial infarction. Metoprolol (15 mg i. v. followed by 200 mg day-1 orally) or placebo was administered in a double-blind, randomised fashion with a median delay of 5.9 hours from onset of symptoms. After 15 days of double blind therapy all patients were started on open treatment with metoprolol. All patients underwent haemodynamic monitoring for 24 hours and serial radionuclide ventriculography and thallium 201 scintigraphy.In the first hour metoprolol produced a decrease in cardiac output (1.3 l min-1; P<0.001) due to a reduction in heart rate (15 min-1; P<0-001) and a decrease in left ventricular stroke work index (10.7 g m m2; P<0.001) due to a reduction in mean arterial pressure (10 mmHg; P<0.001). There was then a gradual attenuation in these changes. While metoprolol produced an increase in pulmonary capillary wedge pressure and in both end-diastolic and end-systolic volumes (P<0.05), these changes were confined to patients with a baseline pulmonary capillary wedge pressure below the median of 13 mm Hg mercury. There was no significant change in stroke volume or in ejection fraction in response to metoprolol. There was no significant difference between the groups in left ventricular performance, as assessed by radionuclide ventriculography, or in scintigraphic infarct size, either at the end of the 15 days double-blind treatment or after 3 months open treatment with metoprolol.Thus, early intervention with metoprolol in acute myocardial infarction appeared to reduce myocardial oxygen consumption with no adverse haemodynamic effect. However, metoprolol failed to preserve left ventricular function, or to reduce apparent infarct size. These data suggest that the modest reduction in mortality reported in the acute phase studies of beta-blockade in myocardial infarction, is unlikely to be due to infarct reduction. It is more likely to be due to a secondary prevention or to an antiarrhythmic effect.

Key Words: Beta-blockade, • myocardial infarction.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
A. Halkin, C. L. Grines, D. A. Cox, E. Garcia, R. Mehran, J. E. Tcheng, J. J. Griffin, G. Guagliumi, B. Brodie, M. Turco, et al.
Impact of intravenous Beta-Blockade before primary angioplasty on survival in patients undergoing mechanical reperfusion therapy for acute myocardial infarction
J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1780 - 1787.
[Abstract] [Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.