The organization of coronary care units in the 1960’s to treat lethal arrhythmias and the development of thrombolytic therapy in the 1980’s to reduce infarct size are the two major therapeutic advances which have reduced mortality due to acute myocardial infarction (MI). Nevertheless, mortality rates associated with cardiogenic shock, the most common cause of death in patients hospitalized with acute MI, remain high and relatively unchanged by modern cardiac intensive care unit interventions including vasopressor and inotropic drug infusions, hemodynamic monitoring, and intraaortic balloon counterpulsation1. Preliminary evidence, however, suggests that there may be a survival advantage for selected patients who achieve sustained infarct artery patency and myocardial reperfusion. The economic cost of aggressive and prolonged intensive care, cardiac catheterization, andcoronary revascularization in a subgroup of patients with 65–80% hospital mortality rates has obvious medical resource utilization implications. It is the purpose of this chapter to review the acute cardiogenic shock syndrome and currenttreatment options. A risk stratification scheme will be suggested to assist in selecting those patients who might benefit from the more expensive interventions.
KeywordsMitral Regurgitation Cardiogenic Shock Left Bundle Branch Block Multivessel Disease Infarct Zone
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- 1.Bates ER, Moscucci M. “Post-myocardial infarction cardiogenic shock”, in: Brown DL (ed), Cardiac Intensive Care, WB Saunders Co., Philadelphia 1998, pp215–217.Google Scholar
- 2.Bates ER, Stomel RJ, Hochman JS, Ohman EM. The use of intraaortic balloon counterpulsation as an adjunct to reperfusion therapy in cardiogenic shock. Int J Cardiol (in press)Google Scholar