American College of Physicians: Internal Medicine — Doctors for Adults ®

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Medical management following myocardial infarction

The latest evaluation, management and treatment strategies

Beta Blockers
Exercise Stress Testing

Drug Therapy

Non-drug Therapy

Follow-up

Myocardial infarction (MI) is the leading cause of death in the U.S. According to the American College of Cardiology/American Heart Association's most recent guidelines for managing acute MI, 250,000 of the approximately 800,000 people in the country affected by MI annually die before reaching the hospital.

The survival rate for patients who receive timely medical care—consisting of therapies to restore coronary blood flow—is 90% to 95%. But patients who survive MI still may face a difficult recovery. Medical management of post-MI patients often requires unwelcome lifestyle changes, compliance with new medication regimens, and coping with significant psychological after-effects. These changes are important in order to prevent subsequent events including death, reinfarction, and rehospitalization as well as minimize left ventricular (LV) remodeling and prevent arrhythmias and progression to heart failure. Patients also may need assistance with the transition back to regular life after MI.

The evaluation and follow-up of patients who have experienced MI begins before hospital discharge and consists of establishing a stable medical regimen and deciding on further noninvasive or invasive evaluation of the underlying coronary artery disease (CAD) and its potential complications.

For post-MI care to be effective, open and supportive communication between the patient and physician is perhaps more important than anything because it reinforces the message that targeted prescription regimens and lifestyle changes can greatly reduce the risk for reinfarction. This supplement to the ACP Observer provides clinicians updated information on the best evaluation, management and treatment strategies for the post-MI patient.

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