title: Nonthrombolytic intervention in acute myocardial infarction.
abstract: Alternative interventions are available for patients in whom thrombolytic therapy is inappropriate after an acute myocardial infarction. Administration of a beta blocker within the first 24 hours of the patient's admission to the coronary care unit can reduce overall morbidity and mortality within the first 7 days by about 15%. Maintenance therapy with an oral beta blocker can reduce mortality within the succeeding 3 years by about 25%. Esmolol, a unique cardioselective beta 1-adrenergic receptor blocker with a half-life of 9 minutes, can enable some patients with relative contraindications to beta blockers to nevertheless benefit from early beta-blocking therapy. It also is useful in screening patients for subsequent therapy with beta blockers. Those who tolerate the esmolol infusion can be given a long-acting beta blocker. For patients who exhibit intolerance to esmolol, the infusion can be terminated with rapid return to baseline hemodynamics.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115.
authors.forename: J M
authors.initials: JM
authors.lastname: Kirshenbaum
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000818:Animals; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D009566:Nitrates / Q000627:therapeutic use; D011379:Prognosis; D011412:Propanolamines / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D009566:Nitrates; D011412:Propanolamines; D014665:Vasodilator Agents; C036604:esmolol