What is your typical approach to the use of beta blockers in the setting of recent cocaine use amongst patients presenting with cocaine-related MI, arrhythmias, or new-onset heart failure?

I favor using or continuing non-selective beta-blockers in patients presenting with acute cardiac manifestations of recent cocaine use. My preferred agent in this setting is carvedilol.

BB withdrawal has similar manifestations to cocaine-induced alpha receptor activation (minus tachycardia). So continued BB use would be advisable. BB with alpha receptor effects like carvedilol or labetalol are reasonable options in this setting.