Management of Suspected Myocardial Infarction with Hypertension

Introduction to Theophylline Contraindications

The American College of Cardiology recommends that theophylline is contraindicated in suspected myocardial infarction, particularly with elevated blood pressure, as it increases myocardial oxygen demand, causes tachycardia, and can precipitate arrhythmias, worsening outcomes in acute MI 1
The American Heart Association suggests that theophylline increases heart rate and myocardial oxygen consumption, which worsens ischemia in already compromised myocardium 1, 2

The American College of Cardiology recommends aspirin 162-325 mg immediately unless contraindicated, for patients with suspected MI and hypertension 1, 2
The American College of Cardiology suggests nitroglycerin sublingual 0.4 mg every 5 minutes up to 3 doses for ongoing chest pain and hypertension, provided systolic BP remains >90 mmHg 1, 2
The American College of Cardiology recommends beta-blockers as the preferred agents for hypertension in acute MI, as they reduce heart rate, blood pressure, and myocardial oxygen demand 1, 3, 2
The American Heart Association advises that oral metoprolol 25-50 mg every 6-12 hours can be initiated if no contraindications exist 1
The American College of Cardiology suggests IV beta-blockers are reasonable for refractory hypertension or ongoing ischemia in hemodynamically stable patients 1, 3

The American College of Cardiology recommends that beta-blockers should not be given if the patient has signs of heart failure or pulmonary congestion 4, 5, 3
The American Heart Association advises that beta-blockers should not be given if the patient has evidence of low output state 4, 5, 3
The American College of Cardiology suggests that beta-blockers should not be given if the patient has heart rate <60 bpm or >110 bpm 3
The American Heart Association recommends that beta-blockers should not be given if the patient has second- or third-degree heart block 3
The American College of Cardiology advises that beta-blockers should not be given if the patient has active asthma or reactive airway disease 3

The American College of Cardiology recommends selective beta-2 agonists, like albuterol, as safer alternatives if bronchospasm must be treated in MI patients, though they still carry some cardiac risk 1
The American Heart Association suggests addressing the MI first, as bronchospasm management is secondary to preventing myocardial death 2
The American College of Cardiology advises considering that "bronchospasm" symptoms may actually be pulmonary edema from left ventricular dysfunction, which requires diuretics and nitrates, not bronchodilators 4, 5