Step II HTN+Post MI/Angina!!

[mie820]

So in that case what anti-hypertensive meds should we use as 1st line? B- or ACE- or both? If both given in options, what should we pick?

I'd say HTN+angina-> B- as it has anti-ischemic effect (decrease HR, decrease contractility->decrease myocardial work and O2 demand).

While in post-MI, I'd say ACE- 1st line as it prevents modulation of cardiac ms.

Correct me if I am wrong, and please state why?

 

[Doctor4Life1769]

So in that case what anti-hypertensive meds should we use as 1st line? B- or ACE- or both? If both given in options, what should we pick?

I'd say HTN+angina-> B- as it has anti-ischemic effect (decrease HR, decrease contractility->decrease myocardial work and O2 demand).

While in post-MI, I'd say ACE- 1st line as it prevents modulation of cardiac ms.

Correct me if I am wrong, and please state why?

I thought post-MI, a BB is #1 because it is proven to decrease mortality and is cardio-protective. ACEI is also given but is not #1 like a BB is ...

 

[anitay]

beta blocker if you have normal ejection fraction, ACE (I) if EF is low.

 

[mie820]

beta blocker if you have normal ejection fraction, ACE (I) if EF is low.

That's a good point! But what if the EF wasn't mentioned in the question?
I'd say as in post-MI, part of the myocardium is already infarcted (dead), but that doesn't mean that EF is decrease, it could be the same.

So I would agree with what ''doctor4life'' said. Though still need more insight to the point.

Thanks a lot for sharing

 

[Doctor4Life1769]

That's a good point! But what if the EF wasn't mentioned in the question?
I'd say as in post-MI, part of the myocardium is already infarcted (dead), but that doesn't mean that EF is decrease, it could be the same.

So I would agree with what ''doctor4life'' said. Though still need more insight to the point.

Thanks a lot for sharing

BB reduces the risk of a recurrent MI. That's the "cardio-protective" factor.

 

[Kuba]

Boards and Wards seems to imply you put patients on BOTH ACE and BB post-MI.

 

[alphaholic06]

Ideally you would put a patient on both. If you had to choose BB are the better choice because they prevent arrthythmias, which is the #1 cause of death post MI, along with decreasing myocardial O2 demand and other benefits listed above.