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