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November 14, 1986

Management of Congestive Heart Failure in Patients With Acute Myocardial Infarction

JAMA. 1986;256(18):2556-2560. doi:10.1001/jama.1986.03380180118031

SEVERE left ventricular dysfunction induced by extensive infarction is the most common cause of in-hospital death in patients with myocardial infarction.1 Prompt recognition of the clinical manifestations of congestive heart failure and an aggressive approach to therapy that improves hemodynamic performance but does not exacerbate ischemia is essential.

The rationale for the aggressive management of heart failure in patients with acute infarction is based on the concept that infarction evolves over several hours and factors underlying its complications (eg, expansion, recurrent infarction, and myocardial rupture) over several days. Both the extent and complications of infarction are caused by, and are, determinants of hemodynamic factors influencing the balance between myocardial oxygen consumption and oxygen delivery. Therefore, prompt therapy is thought to reduce the extent of infarction, the probability of recurrent injury, and the propensity to expansion and cardiac rupture. Beneficial effects of treatment may lead to improved left ventricular performance