A 63-year-old had an uncomplicated MI treated with PCI 15 months ago. LVEF is 55%; he has no angina, arrhythmia or hypertension but reports fatigue

Question

A 63-year-old had an uncomplicated MI treated with PCI 15 months ago. LVEF is 55%; he has no angina, arrhythmia or hypertension but reports fatigue and resting pulse 46/min on metoprolol. Which recommendation is best?

Accepted Answer

Reduce beta-blocker therapy while maintaining other secondary prevention

Answer

Continue the same beta-blocker dose indefinitely because all post-MI patients require lifelong therapy

Answer

Stop statin therapy because beta-blockade already prevents recurrent infarction

Answer

Add ivabradine to lower the resting pulse further

Answer

Replace aspirin with warfarin in the absence of another anticoagulation indication

Post-myocardial infarction secondary prevention — ABIM Board MCQ

A 63-year-old had an uncomplicated MI treated with PCI 15 months ago. LVEF is 55%; he has no angina, arrhythmia or hypertension but reports fatigue and resting pulse 46/min on metoprolol. Which recommendation is best?