Beta-blockade in acute myocardial infarction: is Swan-Ganz catheterization required before treatment?
Beta-blockade is used increasingly in early acute myocardial infarction (AMI) but may cause congestive heart failure (CHF). It is not known whether Swan-Ganz catheterization is necessary before beta-blockade in AMI. We made a retrospective analysis of 213 patients who underwent Swan-Ganz catheterization within 24 hours of AMI and compared precatheter CHF signs (dyspnoea, lung crepitations and x-ray appearance) with initial pulmonary artery wedge pressure (PAWP). One hundred nine of these patients received beta-blockade after catheterization, 31 did not tolerate beta-blockade. Absence of clinical CHF signs predicted a normal PAWP (less than or equal to 18 mmHg) in 86% of patients (42 of 49) and considerable safety in giving beta-blockade. Beta-blockade had to be stopped because of PAWP increase (greater than 5 mmHg) in 25 of 74 patients with CHF signs vs. 3 of 35 patients without CHF signs (p less than 0.005), and in 9 of 15 patients with high PAWP vs. 19 of 91 patients with normal PAWP (p less than 0.01). Only 2/28 patients (7%) intolerant to beta-blockade had a high PAWP but no clinical CHF. In conclusion hemodynamic intolerance to beta-blockade could have been predicted clinically without prior Swan-Ganz catheterization in 25/28 patients. Patients with CHF signs require catheterization if beta-blockade therapy is to be considered.
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D006328:Cardiac Catheterization / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists