200. What are the indications for ACE inhibitors during an acute myocardial infarction?

Either an ACE inhibitor or angiotensin receptor blocker should be given to all STEMI patients upon hospital discharge. Caution must be used in the acute setting in order to avoid hypotension which can worsen myocardial ischemia. Guidelines give the use of these drugs a class I indication when there is left ventricular systolic dysfunction or if the patient is diabetic. When left ventricular function returns to normal and the patient is not diabetic, the benefits are less clear. Usually ARBs are only given if ACE inhibitors are not tolerate due to cough or other side-effects.