[Acute myocardial infarct with cardiogenic shock].

Cardiogenic shock is the most severe complication of acute myocardial infarction (AMI). The Acute Myocardial Infarction (AMI) complicated with shock has the highest mortality. Between january 1980 and june 1983, 903 patients with AMI were admitted to the CCU of the Instituto Nacional de Cardiolog ía; in 38 of them (4.2%) shock ensued. Of the patients with shock, 52.6% died soon after arrival and 25% died soon after shock developed. Only 10 patients could be controlled with a Swan-Ganz catheter and could be treated according to the hemodynamic features. Nine of them were males, the majority older than 60. Three of the 10, had a previous myocardial infarction, 4 had angina 1 arterial hypertension, and 1 diabetes. The AMI was anterior in five patients, diaphragmatic and lateral in one, diaphragmatic with right ventricular extension in two, lateral in one and antero septal in the last one. The clinical manifestations of angina persisted in 6. The shock state appeared in most of the cases during the first 6 hours. The PWP was higher than 18 mm Hg in all the patients. The cardiac index was less than 2, the systemic blood pressure under 90 mmHg and the peripheral resistance was elevated in all the cases. They were treated with digitalis, Dopamine and Sodium Nitroprusiate . Nine of the 10 patients died; five had post mortem examination. The coronary arteries were occluded with a recent thrombi and the necrosis involved more than 40.0% of the ventricular mass.(ABSTRACT TRUNCATED AT 250 WORDS)