Heart failure complicating acute myocardial infarction

Older people with congestive heart failure associated with acute myocardial infarction should be treated with loop diuretic therapy. Class I indicatio ns for the use of early intravenous beta blockade in patients with acute my ocardial infarction are patients without a contraindication to beta blocker s who can be treated within 12 hours of onset of myocardial infarction; pat ients with continuing or recurrent ischemic pain; and patients with tachyar rythmias, such as atrial fibrillation with a rapid ventricular rate. Class I indications for the use of angiotensin-converting enzyme inhibitors durin g acute myocardial infarction are (1) patients within the first 24 hours of onset of a suspected acute myocardial infarction with ST segment elevation in two or more anterior precordial leads or with clinical heart failure in the absence of significant hypotension or contraindications to the use of angiotensin-converting enzyme inhibitors, (2) patients with myocardial infa rction and a left ventricular ejection fraction of less then 40%, (3) and p atients with clinical heart failure on the basis of systolic pump dysfuncti on during and after convalescence from acute myocardial infarction. No clas s I indications exist for using calcium channel blockers or magnesium durin g acute myocardial infarction.