Management of Shock in Acute Myocardial Infarction

Abstract

Shock complicating acute myocardial infarction contributes materially to the over-all mortality. The wisdom of combating the shock has been a matter of dispute, many clinicians holding that the fall in blood pressure has the salutary effect of reducing the work of an acutely injured heart. This report deals with a four-year experience in active intervention for shock. The data suggest that timely intervention for shock is frequently life-saving, and may be instrumental in halving the mortality of the sickest patients.

Myocardial Ischemia Presenting with Hiccups

“…The underlying etiology was myocardial infarction in 127 (98.4%) patients, 5,[7][8][9][10][11][12][13][14][15][16][17][19][20][21][22][23][24][25][26][27][28][29] and myocardial ischemia in 2 (1.6%) patients. 6,18 Of the myocardial infarction group, one patient each was diagnosed with Dressler syndrome, 16 associated with ischemic cardiomyopathy and atrial fibrillation, 15 and had in-stent thrombosis of the right coronary artery.…”

“…15 The situation of hiccups among other symptoms was described in 21 (16.3%) patients: hiccups as an only presentation of myocardial infarction in 7 (33.3%) patients, 5,10,12,14,21,27 as a primary symptom in 8 (38.1%) patients, [6][7][8]15,20,23,29 and as an accompanying symptom in 6 (28.6%) patients. 13,[16][17][18][19]26 Hiccups could be defined according to Thompson and Brooks' classification in 21 (16.3%) patients: Hiccups were persistent in 15 (71.4%) patients, [5][6][7][8]12,14,17,18,21,23,26,27 and intractable in 6 (28.6%) patients, 10,13,15,19,20,29 ( 2 =7.71, p=0.013). In two patients, persistent hiccups were recurrent, induced by exertional effort.…”

“…5,6,8,10,12,[14][15][16]21 The initial therapeutic attempts failed in 13 (10.1%) patients for 11.3 ±5.7 days (n=9). 4,5,7,9,11,13,15,18,25 The effective therapeutic regimens by medications were reported in 8 patients for 19.2 ±40.9 days (n=8). 6,10,12,[14][15][16]20,21 The agents with minimal effects for hiccups were also reported with the use of metoclopramide, triflupromazine, levodopa, digestive enzymes, and homeopathic products.…”

“…15 Treatment of choices was described in 21 (16.3%) patients: 12 (57.1%) patients received an etiologic treatment with anti-myocardial ischemia agents or percutaneous coronary intervention. 6,7,10,12,13,16,18,21,23,27,29 Nine (42.9%) patients received symptomatic treatment. 5,8,14,15,19,20,25,26 One patient died suddenly before proper treatment was started.…”

Rapid Cold Plasma Infusion Treatment for Severe Shock (Peripheral Failure) Following Coronary Occlusion†

“…In this category one finds the lowest percentage of recoveries. Most authorities agree that the mortality rate is at least 80 per cent (1–3). The patient presents a clinical picture of collapse—cold, clammy and markedly cyanotic skin; unconsciousness or, at best, a semi‐comatose state; a weak pulse with distant heart sounds; and a systolic blood pressure of 80 mm.…”