Diagnosis
- n/a
Investigation
- GP follow Up including: BP, renal function
- Offer assessment of LV function
Management
Cardiac rehabilitation programs
Range of options with an exercise component to meet needs of all ages, including those with LV dysfunction, taking account of health beliefs.
- Rehabilitation programs should include health education and stress management, though not CBT routinely
- Use of metabolic equivalents (METS) can be used to compare activities
- Sexual activity can resume 4 weeks after MI, PDE5 inhibitor may be considered 6 mths after event who are now stable (though avoided in patients treated with nitrates)
- Lifestyle changes
- Diet: Mediterranean (more fish, bread, less meat, more plant oils), note omega 3 fatty acid has no evidence of benefit or harm
- Alcohol reduction 3-4 /day men, 2-3 women
- Smoking cessation
- Exercise 20 mins a day till become slightly breathless and aim to extend
- Weight management advice
Medical therapy
- ACE or ARB if intolerant, as soon as haemodynamically stable, and renal function testing 1-2 wks
- Beta Blocker, as soon as haemodynamically stable, min 12 mths and indefinitely in LV dysfunction
- Cholesterol lowering medication (statin)
- Dual anti-platelet (aspirin plus other anti-platelet), unless they have an indication for anti-coagulation. Clopidogrel monotherapy if aspirin not tolerated, or if other clinical vascular disease
- Ticagralor with aspirin for 12 months if STEMI
- Clopidogrel with aspirin for 12 months in NSTEMI or those with bare metal stent, or STEMI with medical management
- Continue 2nd anti-platelet for up to 12 months if had STEMI and CABG
- If anti-coagulated add aspirin unless there is a high risk of bleeding if patient undergone CABG, balloon angioplasty and medical management, not if stented
- If stented add clopidogrel (not aspirin) to the anti-coagulant regime
- Do not routinely add Ticagrelor or Prasugel to warfarin post MI
- Post 12 months consider need for ongoing anti-platelet treatment taking into account thromboembolic vs bleeding risk and cardiovascular risk
- If heart failure symptoms / signs, consider aldosterone antagonist within 3-14 days, post ACE
- All patients with MI should have cardiologist review for revasculaisation