The treatment of the patient with acute myocardial infarction remains a complex field of endeavour. Undoubtedly thrombolytic therapy, if instituted sufficiently early, holds considerable promise for the immediate prevention of myocardial necrosis. Alone, however, without further endeavours to remove the offending obstruction that precipitated clot formation in the coronary arteries, the procedure is only temporarily palliative. The long-term results of thrombolysis plus coronary angioplasty or bypass surgery are awaited but are unlikely to be universally successful or universally applicable. Moreover for the foreseeable future it is probable that the majority of patients will continue to present with established myocardial infarction. The prognosis of these patients is dominated by the presence or absence of left ventricular failure complicating the acute event. In those without such a sinister complication the evidence available suggests that early treatment with beta-blocking drugs or nitrates may enhance their prognosis although the most that can be expected is that the chances of survival will be improved in only one patient for every 150 treated. Moreover it is impossible to predict the patient who will benefit from such treatment and the improvement in length of life-span that this single beneficiary may expect. The major mortality risk of acute myocardial infarction resides in patients who have lost a substantial amount of muscle which has resulted in pump failure of the left ventricle. Both the short-term and long-term mortality rates in these patients is high. A range of drugs exist with which it is possible to ameliorate the hemodynamic evidence of left ventricular failure.(ABSTRACT TRUNCATED AT 250 WORDS)