Assessment of Echocardiographic and Angiographic Profile With Invasive Central Venous Pressure Monitoring in Patients Admitted With Acute Inferior Wall Myocardial Infarction With Cardiogenic Shock

Background - Cardiogenic shock is the most common cause of death in patients hospitalized with acute myocardial infarction. Inferior wall MI is associated with RVMI in up to 50% of cases. The mortality rate of an inferior wall MI is less than 10 percent. RVMI , RVdysfunction , hypotension, bradycardia, heart block, and cardiogenic shock are associated with higher mortality. CVPis usually raised in cardiogenic shock . This study is done to assess the angiographic prole in patients with IWMI with cardiogenic shock. Methods – This is a prospective observational study done in 150 patients with inferior wall myocardial infarction and cardiogenic shock over a period of 6 months conducted in the department of cardiology, Chengalpattu medical college & hospital. ECG and ECHO were done at admission. Central line was secured at presentation and CVPmonitoring was done before and after saline challenge in patients without pulmonary edema and monitored through out the course. Coronary angiogram was done and angiographic prole assessed using syntax score. Results – Out of 150 patients 92(61.3%) were males and 58(38.6%) were females with mean age 54+ 4.5.Among 150 patients 112 (74.6%) had RVMI and 131 (87.3%) had RV dysfunction on echo .Proximal RCAwas involved in most of the patients 111(74% ) . Most of the patients had angiographic score (Syntax score ) ranging between 18-27 (74.6%) . An average of 850 + 150 ml was required to increase the SBP by 10mmHg. The optimal amount of IV uid needed to treat hypotension or shock and maintain SBP>90mmHg in IWMI with RV dysfunction was 2250 +250ml. CVP was high at presentation in most patients with cardiogenic shock. 117(78%).A positive response to uids was observed when CVP values were < 15mmHg but was unlikely when values were > 15 mmHg . The sensitivity of elevated CVP in predicting RV Dysfunction was 85.71%. Elevated CVPwas statistically signicant with RV dysfunction .(P<0.001) Conclusion –Elevated CVP is statistically signicant with RV dysfunction(P<0.001).It is advisable to administer uids in patients with IWMI with Cardiogenic shock when CVP is < 15mmHg. And it is wise to cautiously administer uids in patients with IWMI with Cardiogenic shock when CVP is >15mmHg. In Patients with CVP values >15mmHg proximal cut RCA off was predominantly seen (P<0.005). CVP can be good predictor of RVdysfunction in IWMI cardiogenic shock and IVuids can be administered based on CVPfor early correction of shock.