Beta blockers heart failure management

Ohlstein EH, Romanic AM. New developments in the use of beta-blockers for the management of heart failure. Expert Opin Investig Drugs. 2004 13 999-1005. 

Gibbs CR, Davies MK, Lip GY. ABC of heart failure. Management digoxin and other inotropes, beta blockers, and antiarrhythmic and antithrombotic treatment. BMJ 2000 320(7233) 495-8. 

Sauls JL, Rone T. Emerging trends in the management of heart failure beta blocker therapy. Nurs Clin North Am. 2005 40 135-148. 

Cardiodepressant drugs, including beta blockers and cardioactive CCAs like verapamil, have usually been avoided in management of heart failure. Recently, survival benefits in heart failure have been demonstrated for specific drugs, including metoprolol. 

Acebutolol is indicated in the management of hypertension and premature ventricular contractions. It is contraindicated in hypersensitivity to beta-blockers persistently sever bradycardia greater than first-degree heart block congestive heart failure, unless secondary to tachyarrhythmia treatable with beta-blockers overt cardiac failure sinus bradycardia cardiogenic shock. The side effects reported for acebutolol include hypotension, bradycardia, CHF, cold extremities, heart block, insomnia, fatigue, dizziness. 

In 12 healthy subjects carvedilol 25 mg twice daily for 7 to 9 days did not alter the effeets of a single 2-mg intravenous dose of levosimendan on cardiac contractility. In addition, the heart rate and diastolic blood pressure responses were not altered, but the systolie blood pressure response was blunted. In a study to eompare levosimendan with dobutamine in patients with severe, low-output heart failure, 33 of the 102 patients receiving levosimendan were also given unnamed beta bloekers. The use of a beta blocker was shown not to reduee the haemodynamie effeets of levosimendan. The authors say this suggests that there may be a place for levosimendan in the management of exaeerbations of heart failure not eontrolled by beta bloekers. ... 

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