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

Abstract

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.

Figure 1

Comparison of short term end points after primary PCI and thrombolysis reperfusion treatment for acute myocardial infarction, from a review of 23 trials. Adapted with permission from Keeley et al.²

Figure 2

Data from a consecutive series of patients with myocardial infarction, showing how total mortality is associated with BNP concentration (pg/ml).

Figure 3

Magnetic resonance imaging scan showing a myocardial infarction—this was a "silent" infarction as the patient had experienced no chest pain.