[Heart failure in acute myocardial infarct and the importance of hemodynamic monitoring].

In his study the author deals with etiopathogenesis, diagnosis and therapy of heart failure in acute infarction of myocardium (AMI) with special attention paid to haemodynamic monitoring. The therapy of AMI is based especially on thrombolysis, or urgent revascularisation. In therapy of left ventricular failure we prefer nitrates, diuretics, and ACE-inhibitors. A severe heart failure requires haemodynamic monitoring and administration of positive inotropic substances (dopamine, dobutamine, amrinone) and sodium nitroprusside. Digoxin is indicated only in atrial fibrillation and flutter with fast response of ventricles. In cardiogenic shock it is necessary to introduce an intraaortic balloon contrapulsation and urgent revascularisation (coronary angioplasty, or aortocoronary bypass). Special attention has to be paid to the diagnosis and therapy of AMI of the right ventricle. We avoid the administration of diuretics, nitrates, or morphine which cause hypotension. The therapy is based on thrombolysis, hypotension requires volume expansion, sustained hypotension needs administration of dobutamine, and haemodynamic monitoring. In case of complete AV block, sequence atrioventricular cardiostimulation is recommended. (Ref. 11.).