Heart failure complicating acute myocardial infarction.
Older people with congestive heart failure associated with acute myocardial infarction should be treated with loop diuretic therapy. Class I indications for the use of early intravenous beta blockade in patients with acute myocardial infarction are patients without a contraindication to beta blockers who can be treated within 12 hours of onset of myocardial infarction; patients with continuing or recurrent ischemic pain; and patients with tachyarrythmias, such as atrial fibrillation with a rapid ventricular rate. Class I indications for the use of angiotensin-converting enzyme inhibitors during acute myocardial infarction are (1) patients within the first 24 hours of onset of a suspected acute myocardial infarction with ST segment elevation in two or more anterior precordial leads or with clinical heart failure in the absence of significant hypotension or contraindications to the use of angiotensin-converting enzyme inhibitors, (2) patients with myocardial infarction and a left ventricular ejection fraction of less then 40%, (3) and patients with clinical heart failure on the basis of systolic pump dysfunction during and after convalescence from acute myocardial infarction. No class I indications exist for using calcium channel blockers or magnesium during acute myocardial infarction.
Department of Medicine, Hebrew Hospital Home, Bronx; and Adjunct Professor, Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York, USA.
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Aronow
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000209:etiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D018579:Patient Selection; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004232:Diuretics