Preventing Heart Failure After Heart Attack

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If you have had a myocardial infarction (MI, or heart attack), your heart muscle has been damaged. If enough damage has been done, you may be at risk of developing heart failure. Taking measures to prevent heart failure is an important aspect of therapy after an MI.


Symptoms and Complications of Heart Failure

For people who have had a very large MI, the risk of heart failure can be quite high. In these patients, the onset of heart failure can be acute, often within the first few hours or days.

But even when an MI causes only a moderate amount of muscle damage, eventual heart failure is a possibility. Appropriate drug therapy and lifestyle changes can be critical in delaying or preventing the onset of heart failure.

What Is Remodeling?

Whether or not heart failure occurs after an MI depends to a large extent on how the undamaged heart muscle responds. After an MI, the healthy heart muscle "stretches" in an attempt to take over the workload of the damaged muscle. This stretching leads to the enlargement of the heart, a process called cardiac "remodeling."

Stretching helps the undamaged heart muscle contract more forcefully, and allows it to do more work. The heart muscle behaves something like a rubber band; the more you stretch it, the more "snap" it has. However, if you overstretch a rubber band, or keep stretching it over and over for a long period of time, it eventually loses its "snap," and becomes flaccid.

Unfortunately, the heart muscle does the same thing. Chronic stretching of the heart muscle causes it to weaken, and heart failure may result. So, while remodeling may help the heart work better in the short term, in the long term, remodeling is a bad thing. If remodeling can be prevented or limited, the risk of developing heart failure diminishes.

How Is Remodeling Measured?

An important part of assessing your health after an MI is to estimate how much cardiac remodeling is taking place. This information can be obtained by doing a MUGA scan or an echocardiogram, two methods of noninvasively visualizing the left ventricle.

A good way to estimate the amount of heart muscle damage caused by an MI, and the amount of remodeling that is occurring, is to measure the left ventricular ejection fraction (LVEF). The LVEF is the percentage of blood ejected by the left ventricle with each heartbeat. With heart enlargement, (that is, with remodeling), the ejection fraction falls. If the LVEF is less than 40% (normal being 55% or higher), then significant muscle damage has occurred. The lower the LVEF, the greater the damage, the more remodeling—and the greater the risk of developing heart failure.

The left ventricular ejection fraction (LVEF) is the percentage of blood ejected by the left ventricle of the heart with each heartbeat. With heart enlargement (known as remodeling), the ejection fraction falls. If the LVEF is less than 40%, significant heart damage has occurred.

Preventing Cardiac Remodeling

Several clinical studies have 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.
  • Have significant beneficial effects in several types of heart disease.
  • Should normally be given to virtually every heart attack survivor unless there are strong reasons not to use them. (Some patients with severe asthma or other lung disease cannot take these drugs.)
  • Can cause side effects such as fatigue, dizziness, poor circulation, gastrointestinal symptoms, sexual dysfunction and weight gain.

There are several different types of beta blockers. The latest (third generation) beta blockers are the drug of choice for heart failure and include carvedilol (Coreg) and nebivolol. A second generation beta blocker used to treat heart failure is bisoprolol (Zebeta) and metoprolol succinate (Toprol).

ACE inhibitors:

  • Significantly improve long-term survival.
  • Reduce the risk of developing heart failure (apparently by preventing or delaying remodeling).
  • Reduce the risk of recurrent MIs, stroke, and sudden death.
  • Can cause side effects like cough, low blood pressure and dizziness, rashes, gastrointestinal upset and a deterioration in renal function.
  • Should not be taken by pregnant women, people with severe kidney disease, or those who have allergic reactions resulting in swelling.

ACE inhibitors, like beta blockers, are considered a must if you have had a heart attack. Commonly used ACE inhibitors include captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril), ramipril (Altace), and trandolapril (Mavik).

Maintaining Cardiac Health

In addition to therapy aimed specifically at preventing heart failure after a heart attack, you will need to make other important lifestyle changes that impact heart health. They include:

Although you can't change the fact that you've had a heart attack, you can likely prevent another and slow the progression of heart disease.

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