Acute Myocardial Infarction with Haemodynamic Deterioration :  These patients may require urgent insertion of intra aortic balloon pump (IABP) followed by PTCA or surgery. 50 per cent of them can be salvaged by surgery or angioplasty. Single most important factor for successful surgery is myocardial protection at the time of surgery. Repel-fusion injury has to be avoided at the end of re-vasculmisation. Cold or warm cardioplegic arrest, controlled aortic reperfusion with warm blood (Hot shot) and allowing an empty beating heart time for full recovery of myocardium have improved surgical results.