Literary review and own data are given on use of L-carnitine in patients with acute myocardial infarction, pulmonary embolism, myocarditis and dilated cardiomyopathy. Pilot clinical study of infusion form of L-carnitine Elcar (0.5-2.0 g daily in first 5-7 days) had shown its positive dose-dependent inotropic effect in 53 patients with acute myocardial infarction and low left ventricular ejection fraction (<40%), compared with similar 24 patients, who haven’t get any metabolic drugs. Elevation of low left ventricular ejection fraction was noted also in cases of pulmonary embolism, myocarditis and dilated cardiomyopathy. Thus, Elcar is an effective, affordable and safe positive inotropic agent. Article also covers the indications for use of Elcar in other areas of medicine - pediatrics, neurology, cardiosurgery, sports medicine.