Treatment of the elderly post-myocardial infarction patient.

Coronary risk factors should be modified in older persons after myocardial infarction (MI). Aspirin 160-325 mg daily and beta blockers should be administered indefinitely. Anticoagulants should be administered post-MI to patients unable to tolerate daily aspirin, to those with persistent atrial fibrillation, and to those with left ventricular thrombus. Nitrates, along with beta blockers, should be used to treat angina pectoris. Angiotensin-converting enzyme inhibitors should be administered after MI to patients who have congestive heart failure, an anterior MI, or a left ventricular ejection fraction of at or below 40%. There are no class I indications for the use of calcium channel blockers after MI. Complex ventricular arrhythmias should be treated with beta blockers. Persons with life-threatening ventricular tachycardia or ventricular fibrillation or who are at very high risk for sudden cardiac death after MI should receive an automatic implantable cardioverter-defibrillator. There are no class I indications for the use of hormonal therapy in postmenopausal women after MI. Indications for coronary revascularization after MI in older individuals are prolongation of life and relief of unacceptable symptoms despite optimal medical management.