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7. A 55-year-old patient presents to you with a history of having recently had a myocardial infarction with a 5-day hospital stay while away on a business trip. He reports being told he had mild congestive heart failure then, but is asymptomatic now with normal physical exam. You recommend which of the following medications?
A) An ACE inhibitor
B) Digoxin
C) Diltiazem
D) Furosemide (Lasix)
E) Hydralazine plus nitrates
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The answer is a. The administration of an angiotensin converting enzyme inhibitor has been shown to prevent or retard the development of heart failure in patients with left ventricular dysfunction and to reduce long-term mortality when begun shortly 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 heart 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.
