Hemodynamic Evaluation of Left Ventricular Function in Shock Complicating Myocardial Infarction

Abstract

Twenty-two patients with shock complicating myocardial infarction were studied hemodynamically and, despite pharmacologic therapy and regulation of intravascular volume, 16 (73%) subsequently expired. Pulmonary artery end-diastolic pressure (PAEDP) or left ventricular end-diastolic pressure (LVEDP) was > 15 mm Hg in 18 of the 22 patients, and cardiac index (CI) was <2.3 liters/min/m2 in 17 of 22 patients. Fourteen of the 18 patients with PAEDP or LVEDP > 15 mm Hg expired, while two of the four patients with a PAEDP or LVEDP < 15 mm Hg survived. Thirteen of 15 individuals with a CI < 2.3 liters/min/m2 died, and four of seven with a CI > 2.3 liters/min/m2 survived. A ventricular gallop (S.) was audible in 15 patients with PAEDP or LVEDP varying from 13 to 60 mm Hg. In 11 patients with an S, who expired, the PAEDP or LVEDP ranged from 22 to 60 mm Hg. Mean peripheral vascular resistance was 41.3 units in survivors and 67.8 units in nonsurvivors. Six of eight patients who did not survive the period of hospitalization had a depressed response to dextran infusion manifested by a greater increase in PAEDP or LVEDP than in CI.Hemodynamic evaluation permitted early identification of measurements associated with 100% mortality despite intensive medical treatment. These findings included: (1) PAEDP or LVEDP > 28 mm Hg and (2) PAEDP or LVEDP > 15 mm Hg in association with a CI < 2.3 liters/min/m2. Patients in cardiogenic shock with these hemodynamic alterations are presumably candidates for cardiocirculatory mechanical assisting devices and possibly for further surgical intervention. Additional Indexing Words: Dextran infusion Digoxin ] Isoproterenol Norepinephrine Prog W ITH the development of intensive coronary care units and continuous electrocardiographic monitoring, significant

Spontaneous changes in left ventricular function over the first 24 hours of acute myocardial infarction: implications for evaluating early therapeutic interventions.

“…[35][36][37][38][39][40][41][42][43][44][45][46] Most studies have compared hemodynamic values obtained during the first days of the infarct to those obtained at later follow-up. These studies generally have indicated that improvement in cardiac performance may occur gradually in the majority of the surviving patients.…”

Management of refractory cardiogenic shock

“…1). The presence of concomitant low systemic vascular resistance and systemic inflammatory response syndrome with cardiogenic shock is associated with the development of sepsis and poor outcomes [30][31][32] .…”

“…For patients with cardiogenic shock owing predominantly to LV failure, right heart catheterization can confirm low cardiac output (cardiac index <2.2 l/min/m 2 ) and high filling pressures (PCWP ≥15 mmHg) 35,32 . For other aetiologies of cardio genic shock complicating AMI, such as ventricular septal rupture, a step-up in oxygen saturation can be seen from the right atrium to ventricle.…”

Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology

“…145 In chronic heart failure, cardiac glycosides reduce symptoms and improve clinical status, thereby decreasing the risk of hospitalization for heart failure without effects on survival. 146,147 In AHF, cardiac glycosides produce a small increase in cardiac output 148 and a reduction of filling pressures. 149 In patients with severe heart failure following episodes of acute decompensation, cardiac glycosides have been shown to be efficacious in reducing the re-occurrence of acute decompensation.…”