Hemodynamic profile in acute myocardial infarction.

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  • Hemodynamic Profile in Acute Myocardial

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Hemodynamic and clinical evaluation of 50 patients with acute myocardial infarction were performed. A majority of patients had depressed left ventricular function, but the level of depression was not uniform and a wide spectrum existed. Left ventricular function curves appeared to demonstrate a peak or plateau with a pulmonary arterial end-diastolic pressure (PAEDP) from 17 to 19 mmHg. There was negative correlation between stroke volume index and total peripheral vascular resistance (TPRI). Mean arterial blood pressure (MABP), TPRI, PAEDP were decreased significantly and cardiac index (CI) was markedly increased after administration of nifedipine. Seventeen patients had congestive heart failure. These patients showed a marked increase in PAEDP and a wide degree of valiability in CI and left ventricular stroke work index (LVSWI). Sixteen of 17 patients with congestive heart failure showed a PAEDP greater than 18 mmHg. Six patients developed cardiogenic shock. In these patients CI and LVSWI were markedly reduced. Two patients showed normal PAEDP. Three patients with septic shock showed a marked increase in CI and a decrease in TPRI. Hemodynamic subsets established by a PAEDP of 18 mmHg and a mean right atrial pressure (MRAP) of 100 mmH2O was beneficial to evaluate the right ventricular function. Four patients with the findings of elevated MRAP out of proportion to PAEDP were diagnosed as right ventricular infarction. Three of them showed normal PAEDP. Two patients who showed hypotension and low CI died with shock. It is concluded that hemodynamic evaluation of patients with acute myocardial infarction is useful in understanding the extent of altered cardiac function, classifying the severity of the clinical state, measuring the response to various treatments and predicting the prognosis of the patient.

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