Treatment after myocardial infarction.
Persons after myocardial infarction (MI) should have their modifiable coronary artery risk factors intensively treated. Hypertension should be treated with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. The blood pressure should be reduced to <140/90 mmHg and to <130/80 mmHg in persons with diabetes or renal insufficiency. The serum low-density lipoprotein cholesterol should be reduced to <70 mg/dl with statins if necessary. Diabetics should have their hemoglobin A1c reduced to <7.0%. Aspirin or clopidogrel, beta blockers, and ACE inhibitors should be given indefinitely unless contraindications exist to the use of these drugs. Long-acting nitrates are effective antianginal and antiischemic drugs. Postinfarction patients at very high risk for sudden cardiac death should have an implantable cardioverter-defibrillator. The two indications for coronary revascularization are prolongation of life and relief of unacceptable symptoms despite optimal medical management.
Aronow
Wilbert S
WS
Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York 10595, USA. wsaronow@aol.com
D000368:Aged; D017147:Defibrillators, Implantable; D003920:Diabetes Mellitus / Q000188:drug therapy; D004035:Diet Therapy; D015444:Exercise; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000628:therapy; D006973:Hypertension / Q000150:complications / Q000628:therapy; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D009204:Myocardial Revascularization; D009765:Obesity / Q000150:complications / Q000628:therapy; D016540:Smoking Cessation