Expansion
The four drugs, plus rehabilitation and risk factor control
Expansion
The four As, plus a B:
- A - Aspirin, lifelong, plus a second antiplatelet for 12 months
- A - ACE inhibitor, titrated to the maximum tolerated dose
- A - Atorvastatin, high intensity, usually 80 mg
- B - Beta blocker, continued at least 12 months, and indefinitely if the ejection fraction is reduced
Add an aldosterone antagonist within 3 to 14 days if there is heart failure with a reduced ejection fraction.
Non-drug measures, which matter as much
- Cardiac rehabilitation, an exercise and education programme that reduces cardiovascular mortality
- Smoking cessation, the single most effective intervention
- Mediterranean style diet, weight and alcohol
- Exercise, at least 150 minutes weekly of moderate activity
- Blood pressure and diabetes control
Driving and work: DVLA rules require 1 week off driving after successful angioplasty and 4 weeks if untreated or unsuccessful; group 2 licences require reassessment.
Sexual activity may resume after about 4 weeks; sildenafil is contraindicated with nitrates and should be avoided for 6 months after an infarct.