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The routine use of intravenous beta blockers in acute myocardial infarction is not recommended, except for the treatment of hypertension or tachyarrhythmias. They are associated with an increase in mortality when used indiscriminately, and are inappropriate for patients with bradycardias, hypotension, and pulmonary congestion, which may be aggravated by this therapy.

Oral beta blockers should be initiated within 24 hours of presentation, in the absence of hypotension or decompensated heart failure. Beta blockers reduce infarct size by lowering the heart rate, contractility, and blood pressure. They also have an antiarrhythmic effect and prevent myocardial rupture.