[Treatment of acute left cardiac insufficiency: a labyrinth without the thread of Ariane?].

The final picture of left ventricular failure depends at least as much upon its four mechanisms of compensation (increase in preload, in afterload, in heart rate and, as an attempt, in myocardial contractility) as upon its primary factor (decrease in contractility). The complexity of all possible combinations between those various factors has good chances to bring about confusion in therapeutics if one doesn't dispose of a method, a kind of Ariane's thread, making it possible (1) to define some wide orientations to start with, and thereafter (2) to state precisely the way out of that labyrinth. This method must be founded on an accurate physiological basis and therefore requires cardiac catheterization. In all cases the purpose is to get an adequate cardiac output with comfort to the patient and at a low cost to his myocardium. Further adjustment of that treatment essentially founded on hemodynamics, must however take into account its uncertain physiological results in various organs, estimated from clinical and biological information.