Discharge Planning for Inferior Myocardial Infarction

Medication Regimen at Discharge

The American College of Cardiology recommends aspirin 75-325 mg daily should be continued indefinitely in all patients without contraindications 1, 3
The American Heart Association suggests clopidogrel 75 mg daily for 12 months after PCI, or as alternative if aspirin contraindicated 3
All patients must receive sublingual or spray nitroglycerin with instructions for use, as recommended by the American Heart Association 5, 6, 3
Statin therapy should be prescribed at discharge to all patients regardless of baseline LDL-C level, with a target LDL-C substantially less than 100 mg/dL, according to the American College of Cardiology 1
Patients with LDL-C ≥100 mg/dL require statin therapy with preference given to high-intensity statins, as recommended by the American College of Cardiology 1, 4
Beta-blockers should be continued after discharge in patients who required them for ischemia control during hospitalization, as suggested by the American Heart Association 5, 6
ACE inhibitors should be started within 24 hours and continued long-term, particularly in patients with heart failure, LV dysfunction, diabetes, or anterior infarction, according to the American College of Cardiology 4

Patients must be instructed that chest discomfort lasting more than 2-3 minutes should prompt them to stop activity immediately and take one dose of sublingual nitroglycerin, as recommended by the American Heart Association 5, 6
If pain does not subside within 5 minutes after the first nitroglycerin dose, or if symptoms are unimproved or worsening 5 minutes after onset, patients should call 9-1-1 immediately, according to the American College of Cardiology 1, 5
Before discharge, patients and caregivers must receive clear, culturally sensitive written instructions about each medication's type, purpose, dose, frequency, and side effects, as suggested by the American Heart Association 5, 6, 3

Diet should be low in saturated fat (<7% of total calories) and cholesterol (<200 mg/day) starting at discharge, as recommended by the American College of Cardiology 1
All patients should be referred to cardiac rehabilitation programs, which reduce all-cause mortality and improve functional status, according to the American College of Cardiology 7, 4
Regular exercise of at least 20 minutes of brisk walking three times weekly should be encouraged, as suggested by the American College of Cardiology 4

Low-risk medically treated patients and revascularized patients should return in 2-6 weeks, while higher-risk patients should return within 14 days, as recommended by the American Heart Association 8
Effective communication between patient and healthcare team enhances long-term compliance with therapies and lifestyle changes, according to the American Heart Association 8

All patients with inferior MI and hemodynamic compromise must be assessed with right precordial lead V4R to detect ST-segment elevation and echocardiogram to screen for RV infarction, as recommended by the American College of Cardiology 9, 2
Patients with RV infarction require specific instructions to avoid nitrates and diuretics which reduce preload, according to the American College of Cardiology 2
After RV infarction with clinically significant dysfunction, delay CABG surgery for 4 weeks to allow recovery, as suggested by the American College of Cardiology 9

Never administer nitrates to patients with suspected RV infarction without first assessing for RV involvement, as this can cause profound hypotension, according to the American College of Cardiology 2
Do not discharge patients without ensuring they have sublingual nitroglycerin and understand its proper use, as recommended by the American Heart Association 5, 6, 3