ACE medication following MI

[Don-T]

  I am a 52 yr. old male who suffered an MI about 13 years ago. MI occurred
  in the left anterior decending artery. I was treated with tPA and
  Angioplasty. I was put on Tenormin and asprin, long term. I have had no
  symptoms since, lead a very active life, do 7 mets on the stress test.
  My Cardiologist recently put me on Vasotec (low dose 2.5mg twice daily)
  "as a long term preventative treatment." My BP prior to the Vasotec usually
  was 130/70. Now my BP is 106/58 at last reading. I do feel some
  lightheadness, especially when I am working at my desk. If I am active,
  then I don't notice it. Is there another purpose for the Vasotec
  other than lowering the BP. Should I try to put up with the lightheadness
  to reap these long term benefits?

[CCF Cardio MD - MTR]

Dear Don, thank you for your question.  ACE inhibitors (which include vasotec) have a significant long-term survival benefit in patients after a MI who have dysfunction of the left ventricle.  Patients who have an anterior MI have even a more dramatic benefit.  Despite excellent treatment with t-PA and angioplasty, you are probably left with some LV dysfunction, so I agree that you should be on an ACE inhibitor, if you can tolerate it. You are on the lowest possible dose of vasotec, but you may not have as much lightheadedness with another ACE inhibitor.  Your lightheadedness sounds like a nuisance, but if you can put up with it, you should continue the vasotec indefinitely.  ACE inhibitors ameliorate a process called remodeling where the left ventricle changes its geometric shape to account for the damaged muscle from the MI.  By ameliorating remodeling, ACE inhibitors appear to reduce the development of congestive heart failure.  That is how the mortality benefit is thought to occur.  Additionally, ACE inhibitors blunt the production of certain hormones in the bloodstream.  These hormones are thought to adversely affect cardiac function.  In addition to aspirin, beta blockers, and ACE inhibitors, all patients post-MI should be treated with a cholesterol lowering agent (lipitor, zocor, pravachol, mevacor) if they have a LDL cholesterol > 100 mg/dl.  So, you may want to ask your cardiologist about your cholesterol.  Otherwise, good luck and I hope you're able to tolerate the vasotec.
Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.