Medical therapy of acute heart failure

The leading pathophysiology of acute heart failure and cardiogenic shock is acute or subacute myocardial infarction. Reperfusion of the occluded coron ary vessel accompanied by adequate support of cardiac function via assist s ystems, preferentially the intraaortic balloon counterpulsation, is the the rapy of choice. Adjustment of preload thigh pulmonary capillary pressure in acute myocardial infarction with small heart, low pulmonary capillary wedg e pressure in patients with large ventricles and chronic heart failure, hig h central venous pressure in patients with right heart failure, and right v entricle myocardial infarction) and afterload (peripheral arterial vasodila tation, recommended systolic arterial pressure 80-90 mm Hg) but not maximiz ation of cardiac output play an important role. Positive inotropic drugs sh ould be considered when these strategies fail. In acute right heart failure in pulmonary hypertension, a preferential pulmonary vasodilatation with in travenous or inhalative prostaglandins or inhalative NO are of utmost impor tance. Systemic hypotension is not a contraindication in this pathophysiolo gy.