From the Guidelines
The goal heart rate (HR) post-myocardial infarction (MI) should be 50-60 beats per minute (bpm) at rest. This target is based on the most recent and highest quality evidence, which emphasizes the importance of titrating beta-blocker therapy to achieve this goal heart rate, as it is associated with more benefit than fixed-dose application alone 1. Beta-blockers, such as metoprolol, carvedilol, or bisoprolol, are the primary medications used to achieve this target, and they should be initiated at low doses and gradually titrated upward as tolerated to reach the target heart rate while monitoring for side effects such as hypotension, bradycardia, or bronchospasm.
Some key points to consider when managing heart rate post-MI include:
- The heart rate should be maintained below 70 bpm during mild to moderate activity
- Regular heart rate monitoring is essential, particularly during cardiac rehabilitation when exercise intensity is gradually increased
- If beta-blockers are contraindicated, non-dihydropyridine calcium channel blockers like verapamil or diltiazem may be considered as alternatives, though they are generally less preferred in post-MI patients
- The use of beta-blockers has been shown to reduce myocardial oxygen demand, decrease workload on the damaged heart, prevent arrhythmias, and allow for better ventricular filling time, ultimately leading to improved outcomes in patients with MI 1.
It is also important to note that the evidence supports the use of beta-blockers in all forms of coronary artery disease, including unstable angina, with the exception of initial heart failure 1. Overall, achieving a goal heart rate of 50-60 bpm post-MI is a crucial aspect of managing these patients and reducing their risk of adverse cardiac events.
From the Research
Goal Heart Rate Post-Myocardial Infarction
The goal heart rate (HR) post-myocardial infarction (MI) is not explicitly stated in the provided studies. However, the studies suggest that heart rate is an important factor in the management of patients with MI.
- A study published in 2018 2 found that an elevated heart rate (≥75 bpm) and a lower pulse pressure (<50 mmHg) were associated with a higher risk of mortality in patients with MI complicated by heart failure.
- Another study published in 2005 3 mentions the use of beta blockers in the management of patients post-MI, which can help to reduce heart rate and improve outcomes.
- A study published in 2021 4 compared the effects of metoprolol and carvedilol on survival after acute MI, and found that patients with a left ventricular ejection fraction ≤40% had improved survival with carvedilol.
Factors Affecting Goal Heart Rate
Several factors can affect the goal heart rate post-MI, including:
- Left ventricular ejection fraction (LVEF) 4
- Presence of heart failure 2
- Use of beta blockers 3, 4
- Pulse pressure 2
Management of Heart Rate Post-MI
The management of heart rate post-MI typically involves the use of beta blockers, which can help to reduce heart rate and improve outcomes 3, 4, 5. The choice of beta blocker and the target heart rate may vary depending on individual patient factors, such as LVEF and the presence of heart failure.