Post-MI Medication Management with Preserved EF and Diastolic Dysfunction

Core Post-MI Medications

The European Society of Cardiology recommends beta-blockers as first-line therapy post-MI, even with preserved ejection fraction, as they reduce mortality and recurrent ischemic events 1, 2.
The American College of Cardiology strongly recommends ACE inhibitors post-MI to reduce cardiovascular mortality and prevent adverse remodeling 3.
The American College of Cardiology suggests considering adding spironolactone or eplerenone given the presence of concentric LVH and diastolic dysfunction, particularly if there are any signs of volume overload 2.
The European Society of Cardiology recommends high-intensity statin therapy post-MI regardless of baseline cholesterol levels for plaque stabilization and mortality reduction 3.

The American College of Cardiology states that non-dihydropyridine calcium channel blockers (verapamil, diltiazem) are contraindicated in the post-MI setting with heart failure features 2, 4, 5.
The American College of Cardiology recommends avoiding NSAIDs and COX-2 inhibitors as they cause sodium retention, worsen heart failure, and increase cardiovascular risk 2.
The American College of Cardiology states that thiazolidinediones are contraindicated due to fluid retention and heart failure exacerbation 2.

The American College of Cardiology suggests using loop diuretics judiciously for symptomatic relief if pulmonary congestion develops, but avoiding excessive diuresis which can compromise cardiac output in diastolic dysfunction 2.
The American College of Cardiology recommends daily weight monitoring to detect early fluid accumulation 2.

The American College of Cardiology recommends serial echocardiography to assess for progression of diastolic dysfunction, development of systolic dysfunction, or changes in LVH 7.

The American College of Cardiology advises not to discontinue GDMT if EF remains preserved, as these medications prevent adverse remodeling and reduce recurrent events even when systolic function appears normal 7.
The American College of Cardiology warns not to use verapamil or diltiazem despite their theoretical benefit for diastolic dysfunction, as they are contraindicated post-MI and in heart failure settings 2, 4, 5.

The American College of Cardiology recommends continuing GDMT indefinitely, as discontinuation leads to relapse in 40% of patients within 6 months, even in those with normalized cardiac function 7.
The American College of Cardiology suggests considering adding SGLT2 inhibitors if diabetes is present or develops, as they have shown benefit in heart failure with preserved EF 7.