The Treatment of Shock Associated with Myocardial Infarction

As a background to the problem of shock associated with acute myocardial infarction, a review of 816 recent consecutive and proved cases has been made. One hundred and sixty-one cases met the arbitrary criteria for the definition of shock. Therefore, shock was found to have occurred in 20 per cent of the patients with myocardial infarction. The mortality was 81 per cent (128 patients died). In the present study, 134 patients with acute myocardial infarction in shock were treated. All of these patients were first treated by strictly routine measures, including digitalis when indicated. Sixty of the 134 patients were relieved by prompt routine therapy given within a three-hour period of time. The remaining 74 patients were treated by (1) retrograde arterial infusion, (2) the newer sympathomimetic drugs such as methoxamine, isopropylnorepinephrine and norepinephrine and (3) other agents such as cholinesterase and cortisone. An evaluation of these methods was made and the over-all mortality of shock as associated with myocardial infarction was reduced from 81 per cent to 48 per cent.