Left ventricular failure may occur following large or recurrent myocardial infarctions and is managed by inotropic drugs, diuretics and sometimes intraortic balloon pump. Angiotensin converting enzyme inhibitors are useful in the management of heart failure and can help in ventricular healing or remodelling. During the time in CCU, education and counselling for the patient and their family is initiated. After CCU the patient is ambulated in the cardiac step downward. Any recurrent chest pain is reported.
Patients receive dietary advice and counselling to stop smoking.
Prior to discharge patients can be stratified into low or high risk groups depending on exercise tolerance, evidence for ongoing ischaemia, left ventricular function and propensity for ventricular arrhythmias. Usual length of hospital stay is 7-10 days and prior to discharge an exercise test is performed as well as a radionucleotide heart pool scan to assess left ventricular function. After hospital discharge patients attend a cardiac rehabilitation programme with further education and a graduated exercise programme. Risk factors for atherosclerosis, eg hypertension, hyperlipidaemia, smoking and diabetes, are assessed and treated. Recent trials have shown prognostic benefit using lipid lowering medications if the serum cholesterol is elevated, particularly with low levels of high density lipoprotein.