Office management after myocardial infarction.
Patients should have their modifiable coronary artery risk factors intensively treated after myocardial infarction. Hypertension should be treated with beta-blockers and angiotensin-converting enzyme inhibitors. The blood pressure should be reduced to less than 140/90 mm Hg or to less than 130/80 mm Hg in patients with diabetes or chronic kidney disease. The serum low-density lipoprotein cholesterol should be reduced to less than 70 mg/dL with statins if necessary. Diabetic patients should have their hemoglobin A(1c) reduced to less than 7.0%. Aspirin or clopidogrel, beta-blockers, and angiotensin-converting enzyme inhibitors should be given indefinitely unless contraindications exist to their use. Long-acting nitrates are effective anti-anginal and anti-ischemic drugs. After an infarction, patients at very high risk for sudden cardiac death should receive an implantable cardioverter-defibrillator. The 2 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
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000628:therapy; D050171:Dyslipidemias / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000628:therapy*; D009765:Obesity / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D016540:Smoking Cessation
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors