Which condition is a contraindication for β-blockers in patients with acute coronary syndrome?

The selection of recent myocardial infarction as a contraindication for β-blockers in patients with acute coronary syndrome reflects an important consideration in managing cardiovascular conditions. While β-blockers are generally beneficial in reducing myocardial oxygen demand and protecting the heart post-myocardial infarction, there are specific situations where their use is cautioned against.

In the context of recent myocardial infarction, the primary concern arises from the risk of compensatory mechanisms post-infarction, such as increased heart rate and contractility. In certain cases, especially when there is significant cardiogenic shock or when the heart function is severely compromised, the use of β-blockers can exacerbate hypotension and lead to further reduction in cardiac output.

In contrast, controlled hypertension, stable angina, and chronic obstructive pulmonary disease may not inherently contraindicate the use of β-blockers. Controlled hypertension often benefits from β-blocker therapy due to their ability to lower blood pressure and reduce heart workload. Stable angina typically indicates a condition where β-blockers are helpful for effort tolerance and ischemic prevention. For patients with chronic obstructive pulmonary disease, careful selection of β-blockers that are more cardioselective can mitigate risks, making their use feasible in such patients if necessary.

Thus, the recent