Myocardial Infarction (MI) most commonly happened due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery.
It was stated that approximately 60% of hospital admissions for acute MI occur in persons older than 65 years of age, and persons older than 75 years account for nearly half of these admissions of patients with MI older than 65 years. As told in other related journal, this article focused at the management of the elderly patient after MI. Risk factors for new coronary events elderly person were cigarette smoking, hypertension, dyslipidemia, diabetes mellitus, higher serum total cholesterol, lower serum HDL cholesterol, higher serum triglycerides, obesity,and physical inactivity.
The use of aspirin or clopidogrel, beta blockers, and angiotensin-converting enzyme inhibitors should be given indefinitely unless contraindications exist to the use of these drugs. low density lipoprotein can be managed with statin if necessary.
The ACC/AHA guidelines recommend as Class I indications for long-term oral anticoagulant therapy after
MI: 1) secondary prevention of MI in post-MI patients unable to tolerate daily aspirin or clopidogrel, 2) post-MI patients with persistent atrial fibrillation, and 3) post-MI patients with left ventricular thrombus. Long-term warfarin should be given in a dose to achieve an INR between 2.0 and 3.0
Postinfarction patients should not receive Class I antiarrhythmic drugs, sotalol, or amiodarone due to its higher mortality after administration trials. None of the studies showed a reduction in mortality by class I antiarrhythmic drugs. An automatic implantable cardioverter-defibrillator should be implanted in postinfarction patients at very high risk for sudden cardiac death. It also said that hormonal therapy should not be used in postmenopausal women with Coronary Artery Disease. Coronary revascularization might be performed, but aggressive medical therapy must be continued.
Long acting nitrates should be administered along with beta blockers to persons after MI who have angina and the use of ACE inhibitors may improve symptoms, quality of life, and exercise tolerance in patients with CHF and an abnormal
LVEF or a normal LVEF . The table showed us right here.
Effect of Angiotensin-Converting-Enzyme Inhibitors on Mortality in Persons After Myocardial Infarction
| Study | Follow-Up | Results |
| Survival and Ventricular Enlargement Trial | 42 mo (up to 60 mo) | In patients with MI and LVEF <=40%, compared with placebo, captopril reduced mortality 8% in patients aged <=55 y, 13% in patients aged 56–64 y, and 25% in patients aged >=65 y |
| Acute Infarction Ramipril Efficacy Study | 15 mo | In patients with MI and clinical evidence of CHF, compared with placebo, ramipril decreased mortality 2% in patients aged <65 y and 36% in patients aged >=65 y |
| Survival of Myocardial Infarction Long-Term Evaluation Trial |
1 y | In patients with anterior MI, compared with placebo, zofenopril reduced mortality or severe CHF 32% in patients aged <65 y and 39% in patients aged >=65 y |
| Trandolapril Cardiac Evaluation Study | 24–50 mo | In patients, mean age 68 y, with LVEF <=35%, compared with placebo, trandolapril reduced mortality 33% in patients with anterior MI and 14% in patients without anterior MI |
| Heart Outcomes Prevention Evaluation Study | 4.5 y (up to 6 y) | In patients aged >=55 y with MI (53%), cardiovascular disease (88%), or diabetes (38%) but no CHF or abnormal LVEF, ramipril reduce MI, stroke, and cardiovascular death 22% |
| European trial on reduction of cardiac events with perindopril in patients with stable coronary artery disease |
4.2 y | In patients, mean age 60 y, with coronary artery disease and no CHF, compared with placebo, perindopril reduced cardiovascular death, MI, or cardiac arrest 20% |
LVEF ( left ventricular ejection fraction); CHF (congestive heart failure).
Finally, the overall management approach to elderly persons after myocardial infarction can also be found completely in this journal. Find it in 13 pages of PDF text format (source: biomed.gerontologyjournals.org). Read similar categories of internal medicine journal that you might be interested in.
