cardiovascular disorders
Overview of Acute Coronary Syndromes (ACS)
Rehabilitation and Post Discharge Treatment
Functional evaluation Changes in lifestyle: Regular exercise, diet modification, weight loss, smoking cessation Drugs: Continuation of antiplatelet drugs, beta-blockers, ACE inhibitors, and statins 40% whether or not they received fibrinolytics usually should have Stress Testing of some sort before or shortly after discharge (see table Exercise Capacity Exercise Capacity If ECG Is Interpretable If ECG Is Interpretable If ECG Is Not Interpretable If ECG Is Not Interpretable Able to exercise Submaximal or symptom-limited stress ECG before or after discharge Exercise echocardiography or nuclear scanning Unable to exercise Pharmacologic stress testing (echocardiography or nuclear scanning) Pharmacologic stress testing (echocardiography or nuclear scanning) Physical activity is gradually increased during the first 3 to 6 weeks after discharge. Resumption of sexual activity, often of great concern to the patient and partner, and other moderate physical activities may be encouraged. If good cardiac function is maintained 6 weeks after acute myocardial infarction, most patients can return to all their normal activities. A regular exercise program consistent with lifestyle, age, and cardiac status reduces risk of ischemic events and enhances general well-being. Supervised Cardiovascular Rehabilitation decrease mortality after revascularization ( The acute illness and treatment of ACS should be used to strongly motivate the patient to modify risk factors. Evaluating the patient’s physical and emotional status and discussing them with the patient, advising about lifestyle (eg, smoking, diet, work and play habits, exercise), and aggressively managing risk factors may improve prognosis. Several drugs clearly reduce mortality risk post-MI and are used unless contraindicated or not tolerated: Aspirinand other antiplatelet drugs Beta blockers Angiotensin-converting enzyme (ACE) inhibitors Statins and other Antiplatelet Drugs reduce mortality and reinfarction rates in patients after myocardial infarction. Enteric-coated Beta-Blockers are considered standard therapy. Most available beta-blockers (eg, ACE inhibitors are also considered standard therapy and are given to all post-MI patients if possible, particularly if ejection fraction post MI is<40%. These drugs may provide long-term cardioprotection by improving endothelial function. If an ACE inhibitor is not tolerated because of cough or rash (but not angioedema or renal dysfunction), anangiotensin IIreceptor blocker (ARB) may be substituted. Statins are also standard therapy and are routinely prescribed regardless of lipid levels. Reducing cholesterol levels after MI reduces rates of recurrent ischemic events and mortality in patients with elevated or normal cholesterol levels. Statins appear to benefit post-MI patients regardless of their initial cholesterol level. Post-MI patients whose primary problem is a low HDL level or an elevated triglyceride level may benefit from a fibrate, but evidence of benefit is less clear. The statin should be continued indefinitely, unless significant adverse effects occur, and dose should be increased to the maximally tolerated dose. 1.Goel K, Lennon RJ, Tilbury RT, et al: Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community.Circulation123:2344–2352, 20111. doi: 10.1161/CIRCULATIONAHA.110.983536 2.Visseren FLJ, Mach F, Smulders YM, et al: 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC).Eur Heart J42 (34): 3227–3337 2021. doi: 10.1093/eurheartj/ehab484 3.Wallentin L, Becker RC, Budaj A, et al:Ticagrelorversusclopidogrelin patients with acute coronary syndromes.N Engl J Med361:1045–1057, 2009. doi: 10.1056/NEJMoa0904327 