Cardiovascular Medicine Book

Circulatory Disorders

Electrocardiogram

Myocardial Infarction

Symptoms

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Post Myocardial Infarction Medications

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  1. See Also
    1. Cardiac Risk Management
  2. Tags
    1. C0151744
    2. C0027051
    3. C0948089
  3. Medications: Antihypertensive
    1. Beta Blocker
      1. Start within hours to days of Myocardial Infarction
      2. Taken for life following CAD diagnosis
      3. Contraindications
        1. Overt Congestive Heart Failure
        2. Bradycardia (Heart Rate under 60)
        3. Asthma
      4. Preferred Beta Blockers after Myocardial Infarction
        1. Metoprolol
        2. Timolol
        3. Propranolol
        4. Carvedilol (if decreased ejection fraction)
    2. ACE Inhibitor
      1. Started day 2 following Myocardial Infarction
        1. May be detrimental if given in first 24 hours
      2. Efficacy: Very significant benefit
        1. Lower overall mortality
        2. Lower Cardiovascular death
        3. Lower sudden death
        4. Lower sudden Congestive Heart Failure
      3. References
        1. Kober (1995) N Engl J Med 333:1670
  4. Medications: Miscellaneous
    1. Aspirin or Clopidogrel
      1. See Antiplatelet Therapy for Vascular Disease
    2. AntiHyperlipidemic (HMG-CoA Reductase Inhibitors)
      1. Prescribe a Statin drug in patients discharged post-Myocardial Infarction
      2. Lowers risk of recurrent symptomatic ischemic event
      3. MIRACL study started Lipitor within 96 hours of ACS
      4. Schwartz (2001) JAMA 285:1711
    3. Magnesium oral supplementation
      1. Appears to improve Angina and Exercise tolerance
      2. Shechter (2003) Am J Cardiol 91:517
  5. Medications: Antianginals
    1. Nitroglycerin: Long Acting Nitrates
      1. No evidence that prolongs life
  6. Medications: Specific indications
    1. Warfarin (Coumadin)
      1. Coumadin with Aspirin does not lower mortality rate
        1. Does lower recurrent MI and CVA risk
        2. Rothberg (2005) Ann Intern Med 143:241
      2. Indications
        1. Thrombophlebitis
        2. Large antero-apical Myocardial Infarction
        3. Mural thrombus
        4. Left Ventricular Ejection Fraction under 25%
    2. Implantable Defibrillator Indications
      1. Ejection Fraction <30%
  7. Other Management: Comorbid Major Depression
    1. Major Depression significantly increases mortality
    2. Treat comorbid Major Depression aggressively
    3. See Myocardial Infarction Stabilization for prognosis
    4. References
      1. Bush (2001) Am J Cardiol 88:337

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