[Pathogenesis and fundamentals of treatment in acute myocardial infarct]

Recent findings which extend and render more accurate factors which influence the genesis and course of experimental and clinical acute myocardial infarction change in a significant way the treatment and management of patients with acute infarction. The authors discuss the basic factors and complex of interactions which play the most important part in the pathophysiology of acute infarction. They pay attention also to other factors which can influence in a significant way the course of acute infarction and the patient's prognosis (residual thrombosis, rethrombosis, extension, expansion of the infarction and remodelling of the left ventricle). In recent years it has become obvious that the most important determinants of the final extent of acute infarction is the duration and site of occlusion of the coronary artery, its recurrence and degree (magnitude), the condition of the collateral circulation and the consumption and requirements of the myocardium with respect to oxygen during the time of occlusion. The contemporary reperfusion-thrombotic era of treatment of acute myocardial infarction and management of the patient is based on logical multifactorial and to a certain extent preventive, active or aggressive approach and omission of all even potentially harmful approaches. All therapeutic operations (incl. invasive and radical ones) must be consistent with contemporary pathogenetic findings. They should be implemented before possible reinfarction, sudden cardiac death or treatment which has only little effect on heart failure which may be associated also with undesirable expansion of the infarction and remodelling of the left ventricle after acute myocardial infarction. Recent pathophysiological findings and the development of treatment of myocardial infarction are a challenge for cardiologists of the nineties to make use of these important findings in the treatment of patients with myocardial infarction and to ensure for them optimal treatment and management.