**Author details**

**17. Monitoring**

82 Myocardial Infarction

optimal dosing [1].

occlusion [195].

ered in selected patients.

evaluate and monitor ventricular function [1].

let therapy in patients with coronary artery stents [196].

**18. Management of patients with cardiogenic shock**

Patient monitoring after discharge is essential part of patient care. A follow-up should be arranged within the first 1 to 2 weeks of discharge and monthly visits should be scheduled thereafter. Lipids should be monitored at least every 6 months until a target LDL <70 mg/dL is reached in patients who have had an MI or have CAD. The need for follow-up cardiac ultrasounds is at the discretion of the physician. However, cardiac ultrasounds are necessary to

Smoking cessation, promotion of physical activity and joining the cardiac rehabilitation is extremely helpful. Psychosocial risk factors such as anxiety and depression should be addressed. Depression in particular has been associated with a poor prognosis [194]. All medications should be reviewed at every follow-up visit to encourage patient compliance and

In patients who have undergone direct reperfusion, further noninvasive stress testing or further imaging is indicated only if stenosis of intermediate severity (luminal narrowing of 50–70%) is present in a non-culprit artery. Patients with recurrent ischemic-type pain after reperfusion may need angiography after medical therapy to evaluate for further stenosis or

All patients, regardless of whether a stent was placed, should be treated with a P2Y12 receptor inhibitor for up to 12 months and low-dose aspirin daily as long as tolerated. This should be given for 1 month after bare-metal stent implantation, 3 months after sirolimus drug-eluting stent implantation, 6 months after paclitaxel drug-eluting stent implantation, and ideally up to 12 months if they are not at high risk for bleeding [195]. A scientific advisory from several major health organizations describes the risks of premature discontinuation of dual antiplate-

Cardiogenic shock may develop in up to 3% of NSTE-ACS patients during hospitalization and has become the most frequent cause of in-hospital mortality in this setting [197–199]. One or more partial or complete vessel occlusions may result in severe heart failure, especially in cases of pre-existing LV dysfunction, reduced cardiac output and ineffective peripheral organ perfusion. More than two-thirds of patients have three-vessel CAD. Cardiogenic shock may also be related to mechanical complications of NSTEMI, including mitral regurgitation related to papillary muscle dysfunction or rupture and ventricular septal or free wall rupture. In patients with cardiogenic shock, immediate coronary angiography is indicated and PCI is the most frequently used revascularization modality. If the coronary anatomy is not suitable for PCI, patients should undergo emergent CABG. The value of intra-aortic balloon counter pulsation in MI complicated by cardiogenic shock has been challenged [200]. Extracorporeal membrane oxygenation and/or implantable LV assist devices may be considYaser Al Ahmad and Mohammed T. Ali\*

\*Address all correspondence to: rmtali100@gmail.com

Heart Hospital, Hamad Medical Corporation, Doha, Qatar
