Myocardial Infarct (MI)

Post-MI Manangement

discharge all patients on

1. ASA,
2. clopidogrel (or prasugrel),
3. a beta blocker,
4. a statin, and
5. an ACE-i.

In a patient with status post large MI and risk for left ventricular dilation and aneurysm formation, addition to ACE-i or ARB will be beneficial in preventing remodeling.

ACE inhibitors have also been proven to increase survival in patients with an EF <40%

NICE now recommend:

• post acute coronary syndrome (medically managed): add ticagrelor to aspirin, stop ticagrelor after 12 months
• post percutaneous coronary intervention: add prasugrel or ticagrelor to aspirin, stop the second antiplatelet after 12 months
• this 12 month period may be altered for people at a high-risk of bleeding or those who at high-risk of further ischaemic events

Aldosterone antagonists

• patients who have had an acute MI and who have symptoms and/or signs of heart failure and left ventricular systolic dysfunction, treatment with an aldosterone antagonist licensed for post-MI treatment (e.g. eplerenone) should be initiated within 3-14 days of the MI, preferably after ACE inhibitor therapy

Myocardial hibernation

refers to a state of chronic myocardial ischemia in which both myocardial metabolism and function are reduced to match a concomitant reduction in coronary blood flow (due to moderate/severe flow-limiting stenosis).

This new equilibrium prevents myocardial necrosis.

Chronically hibernating myocardium demonstrates decreased expression and disorganization of contractile and cytoskeletal proteins, altered adrenergic control and reduced calcium responsiveness.