Management of heart failure complicating acute myocardial infarction

Development of heart failure complicating acute myocardial infarction is directly related to the extent of myocardial infarction and complex architectural changes defined as infarct expansion and remodeling. ACE inhibitors are an exciting class of agents that have the potentiality to prevent left ventricular dilatation, evolution of heart failure and death in the acute myocardial infarction setting. Besides, reperfusion is a important intervention that prevents infarct expansion in the early period after myocardial infarction. Early reperfusion limits expansion by infarct size reduction while late reperfusion reduces expansion independent of myocardial salvage by limiting transmural damage and improving the infarct healing. Therefore, reperfusion therapy decreases the incidence of congestive heart failure and significantly improves the prognosis of heart failure. On the other hand, the in-hospital mortality rate of cardiogenic shock, resulting from acute myocardial infarction, remains high, although primary PTCA has apparently resulted in substantial improvement in mortality of myocardial infarction shock. Thus, reperfusion treatment may be more effective in preventing rather than treating cardiogenic shock.