Heart failure post-myocardial infarction: a review of the issues

H Dargie

Correspondence to:
Correspondence to:
Professor Henry Dargie
Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK; h.dargie{at}bio.gla.ac.uk

In most patients with heart failure due to left ventricular systolic dysfunction, the underlying cause is coronary heart disease. To reduce progression to heart failure in a patient with acute myocardial infarction, it is important to achieve the earliest possible reperfusion, whether by thrombolysis or primary percutaneous coronary intervention. Every patient with acute myocardial infarction should have an assessment of their left ventricular function, the potential for reversibility should be considered, and reversible ischaemia should be identified. Left ventricular dysfunction does not only occur with ST segment elevation myocardial infarction but is also commonly associated with non-ST segment elevation myocardial infarction. Secondary prevention is crucial and this requires long term commitment by the patient and the health care system. Heart failure and left ventricular dysfunction are treatable but require a multidisciplinary, integrated network approach.

Abbreviations: BNP, B-type natriuretic peptide; CAPRICORN, carvedilol post-infarct survival control in LV dysfunction; CARE-HF, cardiac resynchronisation in heart failure; CHF, chronic heart failure; COMPANION, comparison of medical therapy, pacing and defibrillation in heart failure; CRT, cardiac resynchronisation therapy; GREAT, Grampian region early anistreplase trial; ICD, implantable cardioverter-defibrillator; LVAD, left ventricular assist device; MADIT II, multicenter automatic defibrillator implantation trial II; MIRACLE, multicenter InSync randomised clinical evaluation; MRI, magnetic resonance imaging; MUSTIC, multisite stimulation in cardiomyopathy; PCI, percutaneous coronary intervention; REMATCH, randomized evaluation of mechanical assistance for the treatment of congestive heart failure; SCD-HeFT, sudden cardiac death in heart failure trial; TACTICS TIMI 18, treat angina with Aggrastat and determine cost of therapy with an invasive or conservative strategy (TACTICS) – Thrombolysis in myocardial infarction (TIMI) 18

Keywords: heart failure; myocardial infarction; left ventricular dysfunction

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