1-ACEI in MI

TheinitiationofACEinhibitorsisrecommendedinallpatientswithanacuteMIwhoare not at lower risk; lower

risk was defined as a normal LVEF, well-controlled cardiovascular risk factors, and performance of
revascularization. For lower-risk patients, we believe it is reasonable to treat with ACE inhibitor therapy.
● ARBsarerecommendedinpatientswhoareintolerantofACEinhibitorsandhaveclinical or radiologic signs of
HF, an LVEF ≤40 percent, or hypertension.
is reasonable to treat with ACE inhibitor therapy. ARBs are recommended in patients
who are intolerant of ACE inhibitors and have clinical or radiologic signs of HF, an
.LVEF ≤40 percent, or hypertension
We start therapy prior to hospital discharge in stable patients with MI. We consider -
starting treatment within the first 24 hours in hemodynamically stable patients with
.large anterior STelevation MI

The use of an intravenous ACE inhibitor is not recommended because of the risk of hypotension

2-SGLT-2 inhibitors in HFrEF VS HFpEF:

-It is recommended in reduced ejection fraction whatever diabetec or not
- In HFpEF patient,SGLT2 inhibitors
(canagliflozin, dapagliflozin(forxiga), empagliflozin, ertugliflozin, sotagliflozin) are
recommended in patients with diabetes at high risk of CV disease or with CV disease
in order to prevent HF hospitalizations.
Indications for Use of an SGLT2 Inhibitor
▪ HFrEF (EF ≤40%) with or without diabetes

▪ NYHA class II–IV HF

▪ Administered in conjunction with a

background of GDMT for HF

3-BNP levels in non-acute heart failure:

NT-proBNP ≥ 125 pg/mL or
BNP ≥ 35 pg/mL
BNP Acute HF:
BNP ≥ 100 pg/mL
NT-proBNP ≥300 pg/mL
MR-proANP ≥120 pg/mL
4-Ivabradine
is a heart-rate-lowering agent that acts by selectively and specifically inhibiting the
cardiac pacemaker current (If), a mixed sodium-potassium inward current that controls
the spontaneous diastolic depolarization in the sinoatrial (SA) node and hence regulates
the heart rate.
 Ivabradine is indicated in chronic heart failure NYHA II to IV class with systolic
dysfunction, in adult patients in sinus rhythm and whose heart rate is ≥ 75 bpm, in
combination with standard therapy including beta-blocker therapy or when beta-
blocker therapy is contraindicated or not tolerated.

5-Drugs recommended in all patients with heart failure with reduced ejection fraction:
An ACE-I is recommended for patients with HFrEF to reduce the risk of HF-
.hospitalization and death
-A beta-blocker is recommended for patients with stable HFrEF to reduce the risk of
HF hospitalization and death.
- An MRA is recommended for patients with HFrEF to reduce the risk of HF
hospitalization and death.
- Dapagliflozin or empagliflozin are recommended for patients with HFrEF to reduce
the risk of HF hospitalization and death.
- Sacubitril/valsartan is recommended as a replacement for an ACE-I in patients
with HFrEF to reduce the risk of HF hospitalization and death.
-Diuretics are recommended in patients with HFrEF with signs and/or symptoms of
congestion to alleviate HF symptoms, improve exercise capacity, and reduce HF
hospitalizations.
- Ivabradine should be considered in symptomatic patients with LVEF equal or more
than 70 b.p.m. despite treatment with an evidence-based dose of beta-blocker (or
maximum tolerated dose below that), ACE-I/(or ARNI), and an MRA, to reduce the
risk of HF hospitalization and CV death.
- Digoxin may be considered in patients with symptomatic HFrEF in sinus rhythm
despite treatment with an ACE-I (or ARNI), a beta-blocker and an MRA, to reduce
the risk of hospitalization (both all-cause and HF hospitalizations.

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Pharmacological treatments to be considered in patients with (NYHA class II–IV)
heart failure with mildly reduced ejection fraction:
- Diuretics are recommended in patients with congestion and HFmrEF in order to
alleviate symptoms and signs.
- An ACE-I or ARBS may be considered for patients with HFmrEF to reduce the risk
of HF hospitalization and death.
- A beta-blocker may be considered for patients with HFmrEF.
- An MRA may be considered for patients with HFmrEFto reduce the risk of HF
hospitalization and death.
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Recommendations for the treatment of patients with heart failure with preserved
ejection fraction:
- Screening for, and treatment of, aetiologies, and cardiovascular and non-
cardiovascular comorbidities is recommended in patients with HFpEF.
- Diuretics are recommended in congested patients with HFpEF in order to alleviate
symptoms