People who have had a
heart attack but who do not have severe chest pain
still may have large amounts of heart muscle at risk of reduced blood flow,
which could make
heart failure worse. Further testing is recommended
for this group of people, beginning with noninvasive testing (thallium
scanning).
Keep in mind, however, that there is currently some debate about
whether surgery to restore blood flow (revascularization) increases the life
span or the quality of life in people who do not have chest pain (angina) along with evidence of reduced blood
flow.
Following a heart attack, some people have heart failure or a reduced
ability to pump blood from the left ventricle of the heart (ejection fraction)
without having symptoms of heart failure. Angiotensin-converting enzyme (ACE)
inhibitors are the cornerstone of therapy for these people. ACE inhibitors
reduce symptoms of heart failure, help prevent the development of heart failure
(if no symptoms are present), may reduce the chance of further heart attacks,
and improve survival rates.