Abstract
The stimulus for the studies I shall describe came from the realization that conventional therapy for the treatment of cardiac failure, namely, digitalis and diuretics, may not be appropriate for failure occurring with acute infarction. This combination of therapy was developed for patients who had chronic cardiac failure primarily from rheumatic valvular disease and cardiac myopathies. These patients had low cardiac output and hypervolemia; thus, diuretics and digitalis were appropriate therapy. In the 1960s, with the introduction of the coronary care unit, failure occurring during the acute phase of myocardial infarction was recognized to be quite frequent, and therapy was instituted similar to that for chronic failure. Yet, it is somewhat obvious that a person with a normal blood volume who has a myocardial infarction and within a few hours develops pulmonary oedema does not necessarily need a diuretic. A patient with clinically recognizable acute pulmonary oedema has lost between 500 and 700 cc of fluid from the vascular space into the lungs, resulting in relative hypovolemia. Thus, the symptoms from failure occurring in association with acute myocardial infarction are due primarily to redistribution of fluid from the vascular space to the lungs; it may therefore be somewhat inappropriate to get rid of fluid and, if not monitored carefully, could in some patients be deleterious. The use of a long-acting inotropic agent such as digitalis, with relative slow onset of action exhibiting maximal effect only after a 24-hour loading dose, would appear somewhat inappropriate for immediate treatment of acute failure which is usually transient. © 1984 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.