Vnitr Lek 1993, 39(6):527-535

[ACE inhibitors in the treatment of patients after myocardial infarct].

J Widimský: Subkatedra kardiologie ILF Praha.

ACE inhibitors are becoming an important part of treatment in patients after acute myocardial infarction if they suffer from asymptomatic dysfunction of the left ventricle (ejection fraction of the left ventricle evaluated by echocardiography or isotope ventriculography 40% or less). It prevents the development of cardiac dilatation, it retards progression of the disease and the development of cardiac failure and reduces the necessity of hospitalization in patients with chronic cardiac failure (stage NYHA II-IV). ACE inhibitors are the drug of choice as they reduce significantly the general mortality of these patients. Treatment should not be initiated in the acute stage but after several days have elapsed after infarction, unless contraindications of treatment are present. Extensive investigations made during the past two years revealed moreover that ACE inhibitors effectively prevent also relapses of myocardial infarction or the development of unstable angina pectoris. Prevention of coronary attacks is most probably due to several effects of ACE inhibitors: a) reduction of blood pressure, b) coronary vasodilatation, c) the antiproliferative action of ACE inhibitors on vascular musculature, d) prevention of progression of atherosclerosis, e) prevention of myocardial hypertrophy, f) the favourable effect on endothelial function. So far we indicate for treatment with ACE inhibitors only patients after acute myocardial infarction with left ventricular dysfunction. Only subsequent research will show whether treatment with ACE inhibitors is of value in patients with preserved left ventricular function.