From the FDA Drug Label
Chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures 1 Major Surgery Chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures 2
Beta blockers should not be held before a cardiac catheterization. The FDA drug labels for metoprolol and atenolol recommend that chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, including cardiac catheterization.
From the Research
Beta blockers should generally be continued before a cardiac catheterization, as abrupt discontinuation can lead to rebound tachycardia, hypertension, and potentially increase the risk of perioperative cardiac events 3. Patients who are on chronic beta blocker therapy (such as metoprolol, carvedilol, atenolol, or bisoprolol) should take their regular dose on the day of the procedure.
Key Considerations
- Beta blockers may provide protection during catheterization by reducing myocardial oxygen demand, controlling heart rate, and stabilizing blood pressure.
- However, there are specific situations where holding beta blockers might be considered, such as:
- Patients with severe bradycardia (heart rate below 50 beats per minute)
- Hypotension (systolic blood pressure below 90 mmHg)
- Decompensated heart failure
- The decision should ultimately be made by the cardiologist performing the procedure based on the individual patient's clinical status, the indication for catheterization, and the specific beta blocker being used.
Recent Evidence
A recent review and expert consensus opinion published in 2023 highlights the importance of beta-blocker management in patients with acute heart failure and reduced ejection fraction 3. While the study focuses on acute heart failure, its findings support the continued use of beta blockers in patients undergoing cardiac catheterization, unless specific contraindications are present.
Clinical Guidance
If there is any uncertainty, patients should contact their healthcare provider for personalized guidance rather than discontinuing these medications on their own. The healthcare provider can assess the individual patient's risk factors and make an informed decision about the management of beta blockers before cardiac catheterization.