Which medication classes are recommended to prevent adverse LV remodeling after myocardial infarction?

• A. ACE inhibitors or ARBs and beta-blockers.
• B. Calcium channel blockers alone.
• C. Nitrates and diuretics.
• D. Statins and antiplatelets.

Answer: (A)

After a myocardial infarction, the heart undergoes structural changes driven by neurohormonal activation, especially the renin-angiotensin-aldosterone system and sympathetic stimulation. Blocking these pathways helps prevent adverse left ventricular remodeling. ACE inhibitors or ARBs reduce angiotensin II–mediated vasoconstriction, afterload, and deleterious remodeling processes, preserving left ventricular geometry and function and lowering mortality. Beta-blockers blunt the detrimental effects of excess catecholamines, lowering heart rate and myocardial oxygen demand, reducing wall stress, and slowing dilation of the ventricle. Together, these classes address the mechanisms that promote remodeling and improve outcomes after MI.

Calcium channel blockers used alone do not prevent remodeling and are not the primary strategy for this purpose. Nitrates and diuretics ease symptoms and volume status but don’t prevent adverse remodeling. Statins and antiplatelets are important for secondary prevention of further ischemic events, but they are not the main agents for preventing LV remodeling after MI.