Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research

Figure 1. Pathophysiology of cardiogenic shock. The primary cause of cardiogenic shock is severe myocardial injury and cardiac dysfunction leading to a supply–demand imbalance in the peripheral end-organs. Early endogenous compensatory mechanisms are activated to prevent the irreversible consequences of hypoperfusion and hypoxemia. Abbreviations: MI myocardial infarction, LV: left ventricular.

Figure 2. Current treatment of cardiogenic shock tailored to its stage. The available therapeutic methods with their classes of recommendation according to the European Society of Cardiology [12] have been assigned to pathological processes within the A to E stages of cardiogenic shock [20]. The personalized, innovative solutions are particularly expected in the higher stages of cardiogenic shock. Abbreviations: IABP: intra-aortic balloon pump, ECMO: extracorporeal membrane oxygenation.

Figure 3. A patient with blowout type of free wall rupture. The acute ostial occlusion of left anterior descending artery (A). Pericardiocentesis (B). A blowout type of anterior wall rupture (C) sutured by a cardiac surgeon (D).

Figure 4. The response of LV pressure–volume loop in cardiogenic shock to short-term mechanical circulatory support. Cardiogenic shock reduces ESPVR slope and diminishes stroke volume (A). IABP reduces systolic blood pressure and increases stroke volume (B). Impella unloads the left ventricle by reducing its end-diastolic volume and pressure (C). ECMO covers peripheral blood demand without unloading of LV end-diastolic function (D). Abbreviations: IABP: intra-aortic balloon pump, ECMO: extracorporeal membrane oxygenation, LV: left ventricular, Ea: effective arterial elastance, EDV: end-diastolic volume, ESV: end-systolic volume, EDP: end-diastolic pressure, ESP: end-systolic pressure, ESPVR: end-systolic pressure-volume relationship, EDPVR: end-diastolic pressure-volume relationship. Green LV pressure–volume loop is for physiological conditions, red for cardiogenic shock, and blue for various types of short-term MCS.

Figure 5. A patient with recanalized ventricular septal rupture initially treated with cardiac surgery. Ventricular septal rupture in transesophageal echocardiography (A,B) and LV angiography (E) treated with the Amplatzer occluder, inserted via the arteriovenous loop (F,G) with a nice effect (D,H). The LV surface of the Amplatzer occluder (C). LV: left ventricular.