Abstract
Prevention of ventricular remodeling after myocardial infarction. Ventricular remodeling after myocardial infarction is defined as slowly progressive structural changes in size and shape of the heart characterised by dilatation and hypertrophy of the myocardium. This unfavourable process induces the congestive heart failure syndrome and leads to death. Main factors contributing to left ventricular remodeling are in infarct size and location, patency of the infarct related artery, neurodendocrine activation and increased wall stress. Medical interventions aim at limitation of infarct size by early reperfusion, at recanalisation of persistently occluded infarct related arteries, at blocking the activated neuroendocrine system using ACE-, AT-II- and betablocking drugs as well as at a reduction of wall stress by hydralazine/nitrate therapy. Effects of these therapeutic measures on left ventricular remodeling in clinical studies are detailed; in addition, it is shown how effects of congestive heart failure drugs on remodeling and mortality may differ from their actions on symptom relief.