Treatment of Pump Failure in Acute Myocardial Infarction

SOME degree of cardiac insufficiency occurs in most patients with acute myocardial infarction (MI), but in many, there are no important clinical consequences and therapy may be more harmful than useful. It is the patients whose clinical condition dictates the need for some therapeutic hemodynamic intervention with which this article will deal. Hemodynamic Monitoring Because MI usually involves the left ventricle, the early clinical manifestations of heart failure are usually those associated with either impaired oxygenation of the arterial blood owing to pulmonary congestion or inadequate peripheral perfusion owing to reduced cardiac output. Cardiogenic shock is an extreme example of both. Although cardiac failure can be recognized at the bedside, misinterpretation of clinical signs is not uncommon, particularly in patients with preexisting lung disease. Likewise, although it is usually possible to recognize inadequate peripheral perfusion at the bedside, the clinical findings associated with reduced cardiac output are not reliable in