Beta-Blocker Selection in Postpartum Cardiomyopathy

Recommended Beta-Blocker

The European Society of Cardiology recommends metoprolol as the preferred beta-blocker for postpartum cardiomyopathy, due to its beta1-selective properties 1, 2, 3
Beta-blocker therapy is indicated for all patients with heart failure from peripartum cardiomyopathy, if tolerated, according to the European Society of Cardiology guidelines 2, 3

The European Society of Cardiology explicitly contraindicates the use of atenolol in peripartum cardiomyopathy, due to fetal risks during pregnancy 1, 2, 3, 4

The American College of Cardiology suggests considering bisoprolol, another beta1-selective agent, as an alternative to metoprolol, due to its established safety profile 4
Propranolol, a non-selective beta-blocker, may also be considered, as it has established safety data, according to the European Society of Cardiology and the American College of Cardiology 4, 5

The European Society of Cardiology recommends initiating beta-blockers during pregnancy if peripartum cardiomyopathy is diagnosed antepartum, using metoprolol as the first choice 2, 3
The American College of Cardiology suggests initiating beta-blockers postpartum immediately once hemodynamically stable, particularly in patients with reduced ejection fraction 2
Newborns should be supervised for 24-48 hours after delivery to exclude hypoglycemia, bradycardia, and respiratory depression when mothers are on beta-blockers, as recommended by the European Society of Cardiology 2, 3

The European Society of Cardiology recommends combining beta-blockers with standard heart failure management, including the use of hydralazine and nitrates for afterload reduction during pregnancy 1, 2
The American College of Cardiology suggests transitioning to full guideline-directed medical therapy, including ACE inhibitors, once hemodynamically stable and bleeding has stopped postpartum 2, 3