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POST MYOCARDIAL INFARCTION CARE.


Murray F. Matangi. MB ChB, FRACP, FRCPC, FACP, FACC.
Cardiologist
Kingston Heart Clinic. 

Objectives. 

(1) Determine the risk profile and prognosis for a post MI patient.
(2) Recognize and treat post discharge MI complications. 
(3) Understand non-pharmacologic and pharmacologic secondary preventative measures.
(4) Specific drug therapy.
(5) Recognize the indications for referral to a specialist. 
(6) Provide answers to questions frequently asked by patients.

The Problem.

There are 18,000 cases of acute MI in Ontario annually. The average 30 day mortality is 15% and the 1 year mortality 23%. The 30 day mortality for men is 12% and for women 19%. The 1 year mortality for men is 19% and for women 30%. 

The 30 day and annual mortality rise progressively with age

Age          Women 30d       1yr             Men 30d      1yr

20-49                        3            4                        2         3

 50-64                       7          12                        5         8

 65-74                     15          23                      13       21

 >75                        28          43                      26       41

Major determinants of risk.

Clinical.

(1) Age.
(2) Site and type of myocardial infarction.
(3) History of prior myocardial infarction.
(4) Congestive heart failure.
(5) Diabetes Mellitus.
(6) Female gender.
(7) Use of thrombolytic Rx during the hospital phase.

Non-invasive.
(1) Echocardiographic/radionuclide left ventricular ejection fraction.
(2) Exercise treadmill tesing.
(3) Ambulatory ECG monitoring.

Invasive.
(1) Left ventricular ejection fraction. 
(2) Severity of coronary artery disease.
(3) Infarct related artery patency.





Post discharge MI complications.

(1) Angina. 
(2) Congestive heart failure.
(3) Depression.


Preventative Measures.

(1) Smoking cessation. 
(2) Control of hypertension.
(3) Control of hyperlipidemia.
(4) Control of diabetes.
(5) Cardiac rehabilitation.






Specific therapy.

(1) Aspirin.
(2) Beta blockers.
(3) ACE Inhibitors.
(4) HMG CoA reductase inhibitors (Statins).
(5) Nitrates.
(6) Amiodarone.
(7) PTCA.
(8) Coronary bypass surgery.


Reasons to refer to a specialist.

(1) Angina.
(2) Symptoms of cardiac decompensation.
(3) Clinical congestive heart failure.
(4) Complex ventricular ectopy.

END.