Post-MI Heart Failure

Please note - The EPG Post-MI Heart Failure Knowledge Centre is for Doctors and other Healthcare Professionals. Enter the Post-MI Heart Failure Knowledge Centre.

Acute coronary syndrome (ACS) is a broad term that includes the diagnoses of unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI).¹ UA and NSTEMI are sometimes referred to collectively as non-ST-segment elevation ACS (NSTE-ACS).²

Regardless of the specific clinical presentation, all cases of ACS result from myocardial ischaemia, usually due to the formation of an occlusive thrombus in a coronary artery following the rupture or erosion of an atherosclerotic lesion.²

Prolonged, severe interruption of the blood flow to the myocardium (15-30 minutes) leads to necrosis, which is the pathological definition of myocardial infarction.^3,4 Complications include heart failure, conduction disturbances, arrhythmias and mitral valve regurgitation.¹

The classic symptom of ACS is chest pain, which is frequently described as retrosternal pressure or heaviness, and may radiate to the jaw, neck or arms.² Other symptoms include diaphoresis, nausea, dyspnoea, abdominal pain and syncope.²

Diagnosis and differential diagnosis is based on a combination of clinical examination, electrocardiography (ECG) and tests for cardiac enzymes (troponins) in the blood.²

Although in-hospital mortality among patients presenting with ACS has declined considerably in recent decades, the risk of dying before reaching hospital has remained relatively unchanged.⁴ Recurrent MI, heart failure and cardiogenic shock are important causes of morbidity and mortality in the ACS population, both during hospitalisation and after discharge.⁵

Following MI, a range of pharmacological and non-pharmacological interventions have been shown to reduce morbidity and mortality from cardiovascular causes.⁴ Antiplatelet agents, beta-blockers, ACE inhibitors and HMG-CoA reductase inhibitors (statins) all have a central role in post-MI care.

Non-pharmacological interventions include implantation of a defibrillator (or cardiac synchronisation device) but also diet and lifestyle modifications, such as smoking cessation and regular exercise.⁴

Enter the Post-MI Heart Failure Knowledge Centre

What’s in the Post-MI Heart Failure Knowledge Centre?

• Definitions and Epidemiology
• Aetiology and Pathophysiology
• Diagnosis
• Management
• Complications and Prognosis
• Risk Factors
• Definitions and Types of Heart Failure
• Epidemiology
• Pathophysiology
• Signs and Symptoms
• Ipmacy
• Diuretics
• Antiplatelet Agent and Anticoagulants
• Beta Blockers
• ACE Inhibitors and Angiotensin II Receptor Blockers
• Aldosterone Receptor Antagonists
• Oral Nitrates and Hydralazine
• Statins
• Digoxin
• Counselling and Education
• Lifestyle Modification
• Invasive Procedures
• Implantable Cardioverter-Defibrillators
• Monitoring
• Guidelines
• Useful Links
• Conferences and Congresses
• Multimedia

Reference:
1. Kumar P, Clark M. Clinical medicine. 7th ed. Edinburgh: Saunders Elsevier, 2009.
2. Bassand J-P, Hamm CW, Ardissino D, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 2007;28:1598-660.
3. Thygesen K, Alpert JS, White HD, et al. Universal definition of myocardial infarction. Eur Heart J 2007;28:2525-38.
4. van de Werf F, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008;29:2909-45.
5. Fox KAA, Steg PG, Eagle KA, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA 2007;297:1892-900.