McMaster Textbook of Internal Medicine

ACE inhibitors after MI

2018-12-11

Gerd Hasenfuß

Recorded at the 4th McMaster International Review Course in Internal Medicine (MIRCIM).

Should all patients after myocardial infarction receive an angiotensin-converting enzyme (ACE) inhibitor?

Gerd Hasenfuß, MD: No. An ACE inhibitor is maybe needed if the patient has hypertension. But it should be definitely given in patients after myocardial infarction with reduced ejection fraction <40%.

It is needed in patients with ejection fraction <40% with heart failure symptoms or without symptoms, because it has been shown long ago that even in patients with New York Heart Association heart failure class I if the ejection fraction is reduced, you can have preventive measures with an ACE inhibitor, in particular after myocardial infarction.

See also

Control of uric acid as part of cardiovascular disease prevention Is it currently recommended to measure the uric acid level in blood and reduce it pharmacologically as part of cardiovascular disease prevention?
Current treatment of dyslipidemia A lecture by Dr Ian Graham, from Trinity College Dublin, Ireland, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Adjusting exercise in patients with heart failure How to adjust the level of exercise in a patient with heart failure?
Management of chronic heart failure: what should we change in our practice A lecture by Dr Piotr Ponikowski, from Wroclaw Medical University, Poland, delivered at McMaster International Review Course in Internal Medicine in Kraków in May 2017.
Cardiac rehabilitation after MI Which patients after myocardial infarction (MI) qualify for cardiac rehabilitation? When should it be started and what should it involve?
Antihypertensive treatment in young patients with mildly elevated BP Should antihypertensive treatment be introduced in young patients with a mildly elevated systolic or diastolic blood pressure?
Heart failure: Diagnosis of rare causes Which patients with heart failure should undergo a thorough diagnosis of rare causes of heart failure such as myopathy or storage diseases?
Heparin in a patient with MI on anticoagulation Should heparin be administered in a patient with myocardial infarction (MI) who is already on long-term oral anticoagulants?
Adverse effects of statins What are the current guidelines for monitoring adverse effects in patients treated with statins?

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