[Diagnosis and drug therapy in the postinfarct phase]

The main goal of all diagnostic procedures after myocardial infarction is the identification of high risk patients. Left ventricular pump function, the extent of coronary artery disease and serious arrhythmias have the strongest impact upon prognosis. Left ventricular pump function can be assessed by echocardiography and radionuclide ventriculography. This is of importance in patients with congestive heart failure to distinguish between a resectable aneurysm and diffusely impaired pump function. Routine application of these methods does not seem necessary since our ability to improve pump function is limited. The extent of coronary artery disease can not be assessed non-invasively. Ergometry does provide us, however, with clinically important data (angina?, ST-depression?, arrhythmia?, drop of blood pressure? etc.) some of which are also predictors of prognosis. Stress testing with low work loads (up to 75 W) should therefore be performed in all patients soon after the infarct on a routine basis. The standard 12-lead ECG is insufficient for the diagnosis of serious arrhythmias. Therefore a 24-hour ECG tape recording would be desirable in every patient, but it is particularly important in patients with poor left ventricular function or premature beats on the resting ECG, who are known to have a high probability of serious arrhythmias. Coronary arteriography is indicated, when the patient is severely symptomatic and when the non-invasive tests indicate that the patient is at high risk. Drug therapy of angina pectoris and arrhythmias after myocardial infarction is basically the same as in patients without a history of infarction.(ABSTRACT TRUNCATED AT 250 WORDS)