Tratamiento de la insuficiencia cardiaca en la fase aguda del infarto de miocardio

Heart failure due to ventricular dysfunction is one of the worst complications of acute myocardial infarction; it increases mortality 2 to 10 times. In addition to muscle loss, the pathophysiology of this condition involves (potentially reversible) ischemia and myocardial stunning, neurohormonal activation, ventricular remodeling, and inflammatory processes. Appropriate treatment requires comprehensive knowledge of the different drugs available, their application in the specific context of acute myocardial infarction, and the best way to monitor treatment hemodynamically. In each individual, it is crucial that any factors that trigger or aggravate heart failure, hypoxemia or acidosis are treated, and that the treatment strategy is guided by the time that has elapsed since the infarction and by the presence of pulmonary congestion, low blood pressure, and peripheral hypoperfusion. Finally, this review places particular emphasis on the efficacy of coronary reperfusion in these patients and on the treatment of cardiogenic shock and right ventricular infarction.