Monitoring
Survivors of acute MI should be closely followed up to ensure adequate modification of risk factors and optimisation of (and adherence to) pharmacotherapy for secondary prevention, as well as to monitor for the development of post MI complications and/or residual angina symptoms. Patients should be evaluated within 2 to 3 weeks of discharge and evaluated periodically based on the extent of myocardial damage and patient condition.
Initiating risk-factor modification and aggressive medical management prior to discharge has been associated with increased patient adherence. All patients should continue the optimal medical regimen indefinitely. This includes dual antiplatelet therapy with aspirin plus ticagrelor, prasugrel, or clopidogrel (for at least 1 year); beta-blockers; statins; and ACE inhibitors (especially in patients with decreased ejection fraction).
Ejection fraction is assessed by echocardiography during the index hospital admission, possibly 3 months after the acute episode (depending on physician discretion and/or institutional protocols) and then periodically thereafter, depending on left ventricular (LV) function and symptoms.[131] Patients with ejection fraction <35% at 3 months' follow-up should be referred to an electrophysiologist for consideration of an implantable cardioverter defibrillator (ICD), as there is a high risk for arrhythmias in this population. Patients who develop diminished LV function and congestive heart failure should be followed up and managed appropriately.
Patients with a history of MI are at increased risk for recurrent infarction. They should be evaluated by stress testing or cardiac catheterisation if symptoms develop. Routine periodic ischaemic evaluations with stress echocardiography or myocardial perfusion studies are controversial.
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