secondary prevention after acute MI

Question 1

to which people should cardiac rehabilitation be offered

Answer 1

all people who have had an MI

Question 2

when should you begin cardiac rehabilitation

Answer 2

as soon as possible after admission and before discharge

Question 3

lifestyle changes afteer MI

Answer 3

smoking cessation
dietary interventions
weight management
moderation of alcohol
regular physical activity
consume oily fish, restrict sodium

Question 4

drug therapy for people who have had MI

Answer 4

ACE inhibitor
DAPT
B blocker
statin

Question 5

use of ACE inhibitor

Answer 5

continue indefinitely
people who are intolerant to ACE inhibitors may be offered an ARB
monitor renal function and blood pressure and serum electrolytes

Question 6

antiplatelet therapy

Answer 6

offer low dose aspirin to all people who have had an MI and continue indefinitely
offer clopidogrel in combination with aspirin as a treatment. option for up to 12 months to people who have had STEMI and recieved a bare metal or drug eluting stent or anyone who has had a NSTEMI

Question 7

for people with aspirin hypersensitivity

Answer 7

consider clopidogrel monotherpay as an alternative

Question 8

for people with history of dyspepsia or history of aspirin induced ulcer bleeding

Answer 8

consider treatment of dyspepsia in line with NICE guidelines if ulcers have healed and patient is negative for helicobacter pylori

Question 9

diagram antiplatelet treatment recommeendations

Answer 9

Question 10

when to prescribe beta blockers

Answer 10

offer as soon as possible after MI when the person is haemodynamically stable
titrate up to the maximum tolerated dose

Question 11

how long to continue beta blockers

Answer 11

continue beta blocker for at least 12 months after MI in people without LV systolic dysfunction or heart failure
continue indefinitely in people with LV systolic dysfunctio