Congestive heart failure in acute myocardial infarction. Treating the spectrum from mild failure to cardiogenic shock.

Congestive heart failure (CHF) accompanying acute myocardial infarction (MI) may have various manifestations, ranging from mild failure to cardiogenic shock. Initial treatment depends on the cause, which is usually determined through careful physical examination. The Forrester hemodynamic classification is useful in this determination. A practical working knowledge of the clinical correlates of left ventricular dysfunction in acute MI allows rational use of the several classes of drugs available to treat CHF. With severe CHF, invasive monitoring is usually required, and mechanical complications of MI need to be identified and managed appropriately.