[Diagnostic possibilities and therapy in the acute phase of myocardial infarct].

An analysis is given for the differential therapeutical drug treatment in the acute phase of myocardial infarction. In first line the correction of hemodynamic disorders is taken into consideration following an exact diagnosis of hemodynamic dysfunction. On that basis different subgroups can be identified. In 5% of the patients exists a hypoperfusion. The therapy of choice is a substitution of volume. 25% of the patients with an acute myocardial infarction develop acute left ventricular failure, with a mortality of 40 to 50%. The treatment of choice in patients with clinical signs of congestion of the lungs but normal cardiac output will be diuretics and vasodilators. In patients with global insufficiency afterload reduction with vasodilators and/or stimulation with positive inotropic substances such as catecholamines has proven successful. Cardiac glycosides have lost their place in the treatment of acute but not of chronic cardiac failure. The use of intraaortic counterpulsation will be reserved for patients with mechanical complications.