Left Ventricular Failure Complicating Acute Myocardial Infarction - Problems and Potential of Nonthrombolytic Therapy

Abstract

Despite recent advances, problems in the treatment of acute myocardial infarction still remain. In the earliest stages of the syndrome thrombolysis holds substantial if not absolute promise but many patients present too late for it to be effective. In these latter individuals and those in whom thrombolysis was not successful, the major mortality risk is concentrated in those with left ventricular failure. Many drugs, including diuretics, vasodilators, ACE inhibitors and positive inotropes, singly or in combination, may be used to manipulate the circulation and correct partially or completely the abnormal circulatory profile. Despite such haemodynamic efficacy the impact of drug therapy on the high morbidity and mortality risk of patients with acute myocardial infarction complicated by left ventricular failure is still unknown.

One-Year Mortality after Acute Myocardial Infarction prior to and after the Implementation of a Widespread Use of Thrombolysis and Aspirin

“…Contributing factors are most likely the improvement in the prehospital care [3], the early detection and treatment of lifethreatening arrhythmias, a more aggressive treatment of pain [4] and congestive heart failure [5] in the acute phase, and the more frequent early use of ß-blockers [6] and possibly nitroglycerin [7].…”

Predictors and importance of congestive heart failure in patients with acute inferior myocardial infarction

“…Previous studies have shown that patients with congestive heart failure complicating acute myocardial infarction have poor prognosis [5][6][7][8][9]. Even in the thrombolytic era, left ventricular dysfunction remains the single most important predictor of mortality following acute myocardial infarction [10,11].…”

Long-Term Survival after Development of Acute Myocardial Infarction Has Improved after a More Widespread Use of Thrombolysis and Aspirin

“…Contributing factors are most likely the improvement in the prehospital care [3], the early detection and treatment of life-threatening arrhythmias, a more aggressive treatment of pain [4]and congestive heart failure [5]in the acute phase, and the more frequent early use of β-blockers [6]and possibly nitroglycerin [7]. …”