Post-CABG Management with Metoprolol and Midodrine

Guideline-Based Recommendations

• The American College of Cardiology and American Heart Association recommend that beta-blockers should be reinstituted as soon as possible after CABG in all patients without contraindications to reduce the incidence or clinical sequelae of atrial fibrillation (Class I, Level of Evidence B) 1, 2
• Beta-blockers should be prescribed to all CABG patients without contraindications at hospital discharge 2

Hemodynamic Monitoring and Management

• Continuous ECG monitoring must be performed for at least 48 hours after CABG to detect arrhythmias 2, 3
• Maintain mean arterial pressure greater than 60 mm Hg, particularly in patients with preexisting renal dysfunction 1

Contraindications and Precautions

• Left ventricular ejection fraction less than 30% is an absolute contraindication to metoprolol use 2

Coordination with Other Post-CABG Medications

• Aspirin should be initiated within 6 hours postoperatively and continued indefinitely 4
• Statins should never be discontinued perioperatively (Class III: HARM to stop) 2, 4
• ACE inhibitors or ARBs should be reinstituted once the patient is stable 2, 4