Myocardial Infarction: Secondary Prevention

Question 1

What drugs should all patients be offered that have had an MI?

Answer 1

• Dual antiplatelet therapy (aspirin plus a second antiplatelet agent)
• ACE inhibitor
• Beta-blocker
• Statin

Question 2

What areas of lifestyle measures should be advised upon?

Answer 2

• Diet
• Exercise
• Sexual activity.

Question 3

What dietary advice should be given?

Answer 3

• Mediterranean style diet
• Switch butter and cheese to plant oil based products.
• Do not recommend omeega-3 supplements or eating oily fish

Question 4

What exercise advice should be given post MI?

Answer 4

Advise 20-30 minutes a day until patients are “slightly breathless”

Question 5

What sexual activity advice should be given post MI?

Answer 5

• Sexual activity can resume 4 weeks after an uncomplicated MI.
• Sex does not increase the chance of another MI.
• PDE5 inhibitors (sildenafil) can be used 6 months after an MI.

Question 6

After an MI, when can Sildenafil be used?

Answer 6

6 months after an MI

Question 7

You cannot prescribe Sildenafil if the patient is taking what drugs?

Answer 7

Nitrates or nicorandil

Question 8

For dual antiplatelet therapy, how long should Clopidogrel be used in a STEMI + bare-metal stent?

Answer 8

12 months.

Question 9

For dual antiplatelet therapy, how long should Clopidogrel be used in a STEMI + drug eluting stent?

Answer 9

12 months

Question 10

For dual antiplatelet therapy, how long should Clopidogrel be used in a STEMI?

Answer 10

1 month

Question 11

For dual antiplatelet therapy, how long should Clopidogrel be used in a STEMI + CABG?

Answer 11

12 months

Question 12

For dual antiplatelet therapy, how long should Clopidogrel be used in a NTEMI (regardless of treatment)?

Answer 12

12 months

Question 13

If someone needs warfarin and is on dual antiplatelet therapy, what should you do?

(e.g. they were on warfarin and then had an MI)

Answer 13

Aspirin OR clopidogrel can be used in combination with warfarin for
unstable coronary artery disease (after an MI, stent or acute coronary syndrome usually for a
period of 12 months)

BUT NEVER ASPIRIN AND CLOPIDOGREL + WARFARIN!!!

After 12 months, stop the antiplatelet and then continue Warfarin.

Question 14

If someone starts to show signs of heart failure or LV systolic dysfunction, what should be initiated within 3-14 days of the MI (and after ACE inhibitor therapy)?

Answer 14

Patients will have an ECHO showing LV function pre-discharge.

Eplerenone will then be started if needed. (Specialist Led)

U&Es are monitored. (If Hyperkalaemia, then halve the dose of Eplerenone)