After myocardial infarction. How to determine future risk and what to do then

Management of the postinfarction patient should be directed toward identifying and treating individuals at risk of future coronary morbidity or mortality. The history, physical examination, resting ECG, and chest film, supplemented with ambulatory electrocardiographi monitoring, noninvasive assessment of left ventricular function, graded exercise testing, and sometime angiography allow stratification of patients into high- and low-risk subgroups. A program of exercise training, risk factor modification, and prophylactic therapy with beta blockers would be warranted in most patients. Use of antiarrhythmic agents may alter prognosis in certain subgroups. Evidence is currently insufficient to warrant routine use of anticoagulant or anti-platelet agents in the post-infarction patient.