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May 9, 1977

Treatment of Shock in Myocardial Infarction

Author Affiliations

From the Department of Medicine, Section of Cardiology, Loyola University Stritch School of Medicine, Maywood, III.

JAMA. 1977;237(19):2106-2108. doi:10.1001/jama.1977.03270460092032

ALTHOUGH shock complicating acute myocardial infarction is a catastrophic event, it should not be approached with an attitude of hopelessness; instead, a stepwise logical evaluation and treatment should be undertaken. Such evaluation and treatment requires adequate monitoring of certain critical hemodynamic measurements since the shock syndrome is, after all, a manifestation of preterminal hemodynamic deterioration. The clinical syndrome includes depression of the CNS as manifested by obtundation, decreased renal perfusion as manifested by oliguria to less than 0.5 ml of urine per minute, and decreased peripheral perfusion as manifested by cold cyanotic extremities. Acute myocardial infarction should be documented electrocardiographically and confirmed by enzyme studies. In addition to a standard ECG for the rhythm changes, hemodynamic monitoring must include a direct measurement of intraarterial pressure and some measure of left ventricular filling pressures. Indirect measurements of left ventricular filling pressure are the pulmonary-capillary wedge pressure and the end-diastolic pressure in