Document Detail

Limitations of thrombolytic therapy for acute myocardial infarction complicated by congestive heart failure and cardiogenic shock.
MedLine Citation:
PMID:  1894853     Owner:  NLM     Status:  MEDLINE    
As many as one quarter of patients treated with thrombolytic therapy present with congestive heart failure or cardiogenic shock. Although thrombolytic therapy has been shown to limit infarct size, preserve left ventricular ejection fraction and decrease mortality in most subgroups of patients, no apparent benefit has been demonstrated in patients with clinical left ventricular dysfunction. The lack of correlation between ejection fraction and other measurements of left ventricular dysfunction such as exercise time, cardiac output, filling pressures, activation of the neurohumoral system and regional perfusion bed abnormalities may partly explain this paradox. Alternatively, lower perfusion rates, higher reocclusion rates, associated mechanical complications or completed infarction may explain these findings. Preliminary data indicate that emergency coronary angioplasty or bypass graft surgery improves survival in selected patients with cardiogenic shock. Because these findings suggest that restoration of infarct artery patency is especially important in patients with clinical left ventricular dysfunction, additional studies are needed in these patients to investigate the potential benefit that new thrombolytic strategies, inotropic or vasodilator agents or intraaortic balloon counterpulsation might offer by augmenting coronary blood flow and improving reperfusion rates. Currently, acute mechanical revascularization should be considered for patients who present with congestive heart failure associated with hypotension or tachycardia and for patients with cardiogenic shock.
E R Bates; E J Topol
Related Documents :
3403793 - Right ventricular dysfunction in patients with septic shock.
11144313 - Survival after intrauterine myocardial infarction: noninvasive assessment of myocardial...
19147243 - Relationship between hyperglycemia and coronary vascular resistance in non-diabetic pat...
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  18     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1991 Oct 
Date Detail:
Created Date:  1991-10-24     Completed Date:  1991-10-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1077-84     Citation Subset:  AIM; IM    
Department of Internal Medicine, University of Michigan, Ann Arbor.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Artery Bypass
Heart Failure / etiology*
Myocardial Infarction / complications,  drug therapy*,  mortality
Myocardial Reperfusion
Shock, Cardiogenic / etiology*
Thrombolytic Therapy*
Ventricular Function, Left / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Influence of calcium administration on the short-term hemodynamic and anti-ischemic effects of nifed...
Next Document:  Comparison of catheter ablation using radiofrequency versus direct current energy: biophysical, elec...