on beta blocker treatment
should be treated: All NYHA I - IV with LVEF <40%. Any age.
only those with proved benefit from randomized trials, despite the cost.
not hesitate in DM or COPD (unless there is asthma or reactive airway disease),
peripheral vascular disease.
to the patient and the family for cooperation and motivation:
How important this medicine is.
may take longer than few months before they feel better from this treatment.
side effects and how to treat them.
- Hospitalized patient.
- 5 -
7 days after intravenous inotropic use for acute decompensation.
- It is safe
to initiate the first dose of beta blocker at least 12 hours before discharge
in stable heart failure patients.
- Only carvedilol was used
in both COPERNICUS and IMPACT-HF trial.
until patient has no fluid retention or has minimal fluid retention first.
to have systolic BP >90.
Heart rate >60.
not have to wait until ACEI reach target dose. Adding beta blocker to low dose
of ACEI is more benefit than increasing dose of ACEI to a higher one first.
(Coreg) 3.125 mg bid.
Succinate CR (Toprol XL) 12.5 mg daily.
(Zebeta) 1.25 mg daily.
the side effects:
the dose in 2 weeks interval or until side effect resolved.
low dose is the only option, only Carvedilol (Coreg) at 6.25 mg bid has proved
occurs within the first 2-6 weeks, including during upward titration.
- Weight daily. Increasing
weight early is managed by adjust diuretic dose.
or symptomatic hypotension. May give ACEI or other medicine that effect BP at
different time, lower the ACEI dose or use low dose (Carvedilol). Correct other
causes of dizziness or hypotension.
May use low dose (Carvedilol).
or heart block. D/C digitalis (less important than beta blocker), reduce the amiodarone
dose, if safe, use low dose (Carvedilol), or implant the pacemaker
should beta blocker be hold or DC
may not feel better for several months, yet beta blocker may prolong life. Adverse
effects are uncommon during long term treatment. Recurrent heart failure is usually
due to progression of the disease.
shock and the patient has signs of hypoperfusion.
< 80 mmHg. However some patients tolerate BP lower than this.
bradycardia, 2nd and 3rd degree block, unless pacemaker is inserted.
reactive air way condition.
not to discontinue beta blocker in the patient who has been on it and was admitted
for treatment of acute heart failure exacerbation unless it is absolutely necessity.