Post infarct heart failure: what to do in addition to ACE inhibition

ACE (angiotensin converting enzyme) inhibitors are revolutionizing the management of heart failure and are now earning themselves a place in the early treatment of post myocardial infarction (MI) patients who have evidence of left ventricular (LV) dysfunction or, more modestly, evidence of infarct expansion. The aims of ACE inhibitor therapy are to control symptoms, if any, and to improve prognosis. For these indications, they are impressive. Nonetheless, they are not a panacea. Post MI patients face a variety of threats, not least from progression of their underlying ischemic disease, and they should not be denied prognostically advantageous interventions, such as beta-blockers and aspirin. Moreover, ACE inhibitor monotherapy may not be the best management for heart failure itself. The role of other additive agents should not be dismissed.