Postmyocardial Infarction Management and Rehabilitation

Nearly two million people in the United States survive an acute myocardial infarc-tion or cardiac surgery each year. Standard textbooks of internal medicine and car-diology have generally contained little information on the special problems facing the family practitioner, internist, or cardiologist, in managing the recovery stage of a patient after myocardial infarction or coronary surgery. Dr. Vyden and the contributing authors from the Cedars-Sinai Medical Center and the UCLA School of Medicine have attempted to answer with their new book the call for a definitive text on the topics of post-myocardial infarction and post-coronary bypass surgery management and rehabilitation. An ideal text on these topics should present the practicing clinician with state-of-the-art practices in assessing risk status of patients surviving myocardial infarction, as well as provide insights into the physiology of exercise, the rationale of cardiac rehabilitation programs, and the specifics in setting up such programs. Unfortunately, this book is flawed in that it is comprehensive yet spotty, and poorly focused in attempting to answer the critical questions of post-MI management. The first two sections deal extensively with diagnostic imaging, including detailed discussion of nuclear and echocardiographic assessment of ventricular function and coronary circulation. These sections are written by experts in these fields; however, they are not particularly relevant to post-myocardial infarction or post-cardiac surgery patients. The second section discusses current concepts in the understanding and management of hyperlipidemia, angina pectoris, and hyperten-sion, and the use of new antiarrhythmic agents. Again, these chapters have been prepared by leading authorities in these highly specialized areas of cardiac disease; however, they also are not specifically tailored to help the clinician manage the patient recovering from a major cardiac ischemic event. For example, the chapter written by Dr. Swan on hemodynamic derangement in acute myocardial infarction is an excellent chapter that would be appropriate in a textbook discussing the management of acute myocardial infarction but really is not relevant in discussing patients who are candidates for cardiac rehabilitation. The third section deals with "Controversies in the Management of the Post Myocardial Infarction Patient." This section provides useful discussions regarding the effects of exercise on the coronary circulation, the indications for coronary arteriography, and the management of risk factors. Again, however, there are some chapters that are superfluous and irrelevant, such as the chapter on the value of glucose-insulin-potassium therapy in acute myocardial infarction. The fourth section, "Cardiac Rehabilitation," deals with selected aspects of …