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What Can Be Done to Prevent Cardiac Remodeling and Heart Failure?
Several randomized clinical trials have now shown that two classes of drugs can significantly reduce remodeling after an MI, and improve the survival of patients who have signs of impending heart failure. These drugs are the beta blockers and the ACE inhibitors.Beta blockers work by blocking the effect of adrenaline on the heart, and they have significant beneficial effects in several types of heart disease.
Beta blockers reduce the risk of angina in patients with coronary artery disease, improve the survival of patients with heart failure, reduce the risk of sudden death in patients after heart attacks, and delay or prevent cardiac remodeling after MIs. In patients with moderate to severe heart muscle damage due to MI, beta blockers can significantly improve survival. So, unless there are strong reasons not to use them (some patients with severe asthma or other lung disease simply cannot take these drugs), virtually every heart attack survivor should be placed on beta blockers. The most commonly prescribed beta blockers after an MI are Tenormin (atenolol) and Lopressor (metoprolol).
ACE inhibitors block angiotensin converting enzyme, and by doing so they produce numerous beneficial effects on the cardiovascular system. The use of ACE inhibitors significantly improves long-term survival after an acute MI, and in addition, reduces the risk of developing heart failure (apparently by preventing or delaying remodeling).
They also reduce the risk of recurrent MIs, stroke, and sudden death. ACE inhibitors, like the beta blockers, are considered a must if you have had a heart attack. Vasotec (enalapril) and Capoten (captopril) are the drugs most commonly used after an MI.
It is also important for you and your doctor to discuss more general measures that will improve your cardiovascular status and prevent heart failure. These include measures to improve your diet, cholesterol levels, exercise capacity, and to optimize your weight and your blood pressure. These measures, of course, are the same ones that will help you to slow the progression of the coronary artery disease that caused your heart attack in the first place.
In summary, after a heart attack it is very important that your doctor assess the condition of your heart muscle, and help you take the steps necessary to limit remodeling of your heart muscle and to prevent heart failure. Indeed, this is one of the main things you should be discussing with your doctor after a heart attack.
Here's More on What You Need to Do After an MI
Sources:
Nuttall, SL, Toescu, V, Kendall, MJ. beta Blockade after myocardial infarction. Beta blockers have key role in reducing morbidity and mortality after infarction. BMJ 2000; 320:581.
Smith, SC Jr, Allen, J, Blair, SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006; 47:2130.