Optimal USE OF BETA-BLOCKERS IN POST-MI PATIENTS with preserved LV function.

Beta-blockers

Has to be started about 24 hrs after PCI or thrombolysis once the patient is haemodynamically stable.

Choice & starting dose would depend on LV function, pulse rate & blood pressure.

Bisoprolol is available in all government hospitals and is a choice for patients with LVEF > 45%

The discharging dose would be the maximum tolerated or maximum recommended dose.

 Bisoprolol has a long half-life and could be given once a day. There is no reason to split it into twice daily dose. The peak plasma level is seen 4 hours after oral administration.

It is usually given in the morning as people are mentally and physically active during the daytime.

With preserved LV function, the target heart rate would be around 55 ( 50 to 60 ) bpm. This would suggest the patient is fully beta- blocked. In such a situation, maximum protection is given in terms of symptoms and survival.

When the patient is fully beta blocked, the increase of heart rate, blood pressure, and the force of myocardial contraction during exercise and exertion is minimal, making a remarkable increase of exercise tolerance.

This is the reason as to why the optimal dose of betablocking is considered the most effective anti- anginal medication.

Please note that the optimal dose is of considerable importance.

If not, patients are denied the optimum benefit of betablocking.

Major trials have shown that optimal betablocking offers both symptomatic & survival benefits. About 15% reduction of fatal and non-fatalal cardiac events are seen during an average of 3 years ofollow-upup.

The benefit of betablocking in patients who underwent primary PCI within the first few hours of onset of pain with no wall motion abnormalities on echo study is clear.

 It is rather sad to see that many ( most) post MI patients are discharged on bisoprolol 2.5 mg dose once daily, which would not offer the desired beneficial effects.

Therefore, I would earnestly request the doctors who are involved in managing immediate post MI patients be responsible & not to deny the benefits of optimum betablocking.

 Make sure the dose is optimised during daily mornings ward rounds as optimum dose has to be achieved during the short hospital stay of 3 to 4 days.