Beta blockers after a heart attack ( and no heart failure)

Definitely interesting, but ...

by LondonAndy - 2017-06-08 13:16:39

... a year is not a long time to find consequences, so I hope that they continue longer term.  Seems to confirm the findings of a similar study published in 2016 which only looked at 2,679 participants but did cover a 5 year term, and found:

Early β blocker use was associated with reduced 30 day mortality in patients with acute myocardial infarction, and discontinuation of β blockers at one year was not associated with higher five year mortality. These findings question the utility of prolonged β blocker treatment after acute myocardial infarction in patients without heart failure or left ventricular dysfunction.

Source: http://www.bmj.com/content/354/bmj.i4801 

MI AND HEART FAILURE

by BOBJ - 2017-06-09 17:53:14

Can you have a heart attack and not have some form of heart failure? This seems to contradict what I understand about heart failure. I mean preheart attack I understand, but once you have a MI aren't you technically in heart failure?

Help!!!!!!

MI and heart failure

by Selwyn - 2017-06-10 15:36:32

You can have a small myocardial infarct ( a bit of non functioning heart muscle due to lack of blood supply) and still not have heart failure. The heart has plenty of reserve capacity.  You only begin the slippery slope of declining heart muscle function when the heart goes downhill due to the strain ( The Frank–Starling Curve), you then have heart failure.

Selwyn 

MI and Heart Failure--or not

by Adagietto - 2017-06-12 00:40:26

Permanent heart damage results from a serious blockage (I think 100%) which lasts long enough for all the heart muscle downstream from the blockage to die.  It doesn't take very long if there is a 100% blockage.  I've read different number of minutes this occurs if the artery is not opened up quickly enough.  The position of the blockage also matters because that determines how much muscle will be deprived of circulating blood.

In my case I called for the ambulance very quickly after the start of any symptom.  Was whisked away to the local hospital and had IV inserted while entering a busy highway.  (The person was good.). That hospital got the artery open with drugs and called for the helicopter.  I was met at the door of the larger hospital by the interventional cardiologist who introduced himself and said that he and his team were ready to take care of me.

Unbeknown to me at the first hospital my son had been told that my ECG showed the "tombstone" pattern.  Doesn't take much to figure that one out.

In the cath lab my artery closed up again 100% and the doctor said he had to suction out the blood clot/s.  I think I got to the cath lab in almost enough time to avoid major permanent damage, but the doctor told me it hadn't really looked like a new heart attack.  Hence my heart failure dx and 30% ejection fraction in hospital which never improved in the 2-year interim (though my symptoms did).  I just dont know how long this may last; I might be in the lull before the next storm.

 [Note to BOBJ:  I sent you a PM because earlier today I failed to answer your questions in my recent thank you reply to those who commented on my question about pacing in order to be able to take a beta blocker.]

I try to encourage my friends to be proactive in trying to avoid a heart attack in the first place. I  think it's great that angioplasties and stents save lives, but also think that it may keep some people from realizing that just because a person survives a heart attack does not mean that they are all truly "fixed."

Time taken to damage the heart if having an acute coronary event.

by Selwyn - 2017-06-12 09:40:04

20 minutes is said to be the window of opportunity once blood supply is compromised to the heart muscle before there is permanent damage. Most hospitals/medics would like you treated within 30 minutes of onset of chest pain ( thrombolytic therapy and or PCI if possible).  Most do not meet that time window.

You definately should not delay in calling for help if you think you are having a heart attack.

Taking 300mg of dispersible aspirin at once is good practice, AFTER you have called the emergency services number.

[PCI = percutaneous coronary intervention]

Selwyn

ADDENDUM

by BOBJ - 2017-06-14 12:15:24

My cardiologist explained to me after my MI. 2 types stemi and nonstemi. This is simply mi with st wave elevation and mi without st elevation. 

The difference is this. Nonstemi only kills heart muscle at surface near the blocage.

Stemi kills the muscle at blockage and beyond and all the way through and anything below the blockage.

Either way at the point this happens stemi or nonstemi you are technically in heart failure.

You may not have HEART DISEASE, but you do have some form of heart failure.

DISREGARD

by BOBJ - 2017-06-15 13:15:37

Please disregard my comments. I just realized you guys live in the UK.

Our guidlines are different than yours on the use of Beta Blockers. 

I stand by my heart failure comment but if you live in the UK I would think long and hard about Beta Blocker reccomendations.