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.