A cardiac rhythm management (CRM) system provides for post-myocardial infarction (MI) therapy with closed-loop control using one or more ultrasound transducers sensing one or more ultrasound signals indicative of cardiac dimensions. Cardiac size parameters are produced using the one or more ultrasound signals to represent, for example, cardiac chamber diameter, cardiac chamber volume, cardiac wall thickness, infarct size, and degree of change in any of these parameters over time or between measurements. In various embodiments, such cardiac size parameters provide for titration, safety check, and acute optimization of the post-MI therapy.