AIM: To assess antiischemic efficacy, safety and effect on myocardial perfusion of a course treatment with mildronate (as monotherapy and in combination with atenolol) in patients with postinfarction left ventricular dysfunction associated with moderate heart failure. MATERIAL AND METHODS: Patients (n=47) with postinfarction cardiosclerosis, angina, and decreased tolerance to physical exertion were divided into 2 groups. Patients of group 1 had functional class II angina and NYHA class I-II heart failure, patients of group 2 had functional class II-III angina and severe heart failure. Mildronate (0.75-1.0 g/day) was used as monotherapy in group 1 and in combination with atenolol (25-50 mg/day) in group 2. Duration of therapy was 3 weeks. RESULTS AND CONCLUSION: The use of mildronate was associated with marked antiischemic effect. Combined administration of mildronate and atenolol resulted in additional antiischemic effect without impairment of hemodynamics in patients with severe heart failure. Course use of mildronate was well tolerated. Adverse effects were registered in 4,2% of cases.