Cardiac remodelling/observation?

65 YO Male presents for routine follow up. He is a F/U case of Anteroseptal MI treated with coronary stent placement in 2016. His LVEF was 42% then. His LVEF has gradually been declining annually. Last year 38, this Visit being 34%. He is presently on Nebivolol, Atorvastatin, Metformin, Ecosprin. He has no symptoms of SOB/fatigue. Does he need any cardiac remodelling agents (aldosterone inhibitors)? Or to be kept on observation?



Acute st elevation in lead v2,3&4 Inverted t wave in lead V3,45&6 Should proceeds for intervention

His systolic function was low even in 2016 post PTCA... probably required aldo antagonist at that time only as 1st 6 months post ptca are crucial from cardiac remodeling point of view... I don't feel they will work now... I suggest close observation and if symptoms of low ejection fraction heart failure develops then to add diuretics and sos digoxin..



If no symptom then keep a close watch & add cardiac remodeling agents stop Nabivolol

Pl keep him under observation if needed ventricular assist divice canbe implanted

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