A 55-year-old patient presents to you with a history of recent myocardial infarction with a 5- day hospital stay while away on a business trip. According to his repos he had mild congestive hea failure then, but is asymptomatic now with normal physical exam. You recommend which of the following medications?
An ACE inhibitor
Digoxin
Furosemide (Lasix)
Hydralazine plus nitrates
(Braunwald, 15/e, pp 1323-1327.) The administration of an angiotensin conveing enzyme inhibitor has been shown to prevent or retard the development of hea failure in patients with left ventricular dysfunction and to reduce long-term moality when begun sholy after an MI. This relates to inhibition of the renin- angiotensin system and to reduction of preload and afterload. Other agents that might be considered for prevention of deterioration of myocardial function include a beta blocker, an angiotensin II receptor blocker, and/or an aldosterone antagonist such as spironolactone. General therapeutic measures also include salt restriction and regular moderate exercise. Digoxin is reserved for those with clear- cut systolic dysfunction. Calcium channel blockers are not indicated for hea failure or routinely post MI. Loop or thiazide diuretics are administered in those with fluid accumulation. The nitrate- hydralazine combination is an option in ACE inhibitor-intolerant patients.