[Progress in the treatment of acute myocardial infarct].

The ultimate causes which lead to acute myocardial infarction are invariably unknown. Accordingly there are also considerable controversial points of view with regard to an aggressive management. Futhermore, concerning the attempts to subdue the primarily developing myocardial necrosis, anticoagulant therapy and fibrinolysis have shown to be ineffective. Their beneficial effect is based only on a secondary hemodynamic improvement. Therefore, present therapy remains principally defensive. It consists in prevention and treatment of complications which either immediately threaten the life of the patient or deteriorate their long-term prognosis by extention of the primary necrosis. All these parameters are thoroughly discussed, especially the use of new antiarrhythmic drugs and the management of cardiogenic shock. However the latest trends of therapy again show a change towards a more aggressive attitude, particularly in attempts to prevent the secondary extention of infarction. The developing acute myocardial infarction should be kept as small as possible. This can be achieved by hemodynamic interventions which reduce cardiac work and oxygen consumption. Principally this is a matter of pharmacological reduction of ventricular afterload and of mechanical assistance utilizing the intra-aortic balloon pump. Finally also the present possibilities of "acute coronary surgery" are delineated, i. e. surgical measurements against impending and developing acute myocardial infarction and its complications.