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. (C) 2010 Published by Elsevier Inc. The American Journal of Medicine (2010) 123, 593-595