["Myocardium in hibernation"--implications for clinical medicine].

Myocardial infarction is one of the leading causes of heart failure. Medical therapy of heart failure is effective in reduction of morbidity and mortality. In spite of intensive pharmacological and non-pharmacological treatment, prognosis of advanced heart failure remains poor. Fibrinolytics and other adjuvant medical strategies have improved prognosis of acute myocardial infarction with a significant reduction in mortality and morbidity. 40% of myocardial segments involved in acute ischemia during myocardial infarction show characteristics of postischemic functional disorder and contraction abnormalities despite reperfusion. Recovery can be observed in the following period spontaneously or after revascularisation procedures when chronic ischemic myocardium can be detected. Presence of viable jeopardized myocardium worsens prognosis and overall outcome in patients with myocardial ischemia and impaired left ventricular function. Revascularisation procedures improve angina functional class, symptoms from heart failure, exercise capacity and survival in patients with impaired left ventricular ejection fraction in the presence of severe coronary artery stenoses and viability of myocardial segments with ischemia-induced contractile dysfunction.