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?
Correct Answer: An ACE inhibitor
Description: (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.
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