On the basis of the development of therapeutical procedures in acute myocardial infarction (AIM) the author offers the current standpoint to the standard medicamentous therapy of this disease. As AIM is caused by thrombotic occlusion of the coronary artery, the main therapeutical position is ascribed to the thrombolytic therapy. An important position is ascribed to acetylsalicylic acid and betablockers. The optimal application is intravenous administration at an early stage of the disease. The ISIS-4 study displayed a beneficial impact on mortality including ACE inhibitors. The symptomatic therapy includes analgetics administered at an early stage of the disease, nitrates and magnesium. Antiarrhythmics are not to be applied in a routine pattern. Cardiogenic shock can be treated exclusively by invasive therapeutical intervention (e.g. direct PTCA or emergent bypass).