Subject(s)
Angina Pectoris/therapy , Angina, Unstable/therapy , Intra-Aortic Balloon Pumping , Shock, Cardiogenic/therapy , Adult , Aged , Angina, Unstable/diagnosis , Angina, Unstable/mortality , Combined Modality Therapy , Evaluation Studies as Topic , Hemodynamics , Humans , Middle Aged , Myocardial Infarction/therapy , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/mortalitySubject(s)
Angina Pectoris/therapy , Angina, Unstable/therapy , Intra-Aortic Balloon Pumping , Adult , Angina, Unstable/diagnosis , Angina, Unstable/physiopathology , Cardiac Catheterization , Combined Modality Therapy , Coronary Angiography , Echocardiography , Electrocardiography , Hemodynamics , Humans , Middle AgedABSTRACT
A. N. Bakulev Institute of Cardiovascular Surgery, Academy of Medical Sciences of the USSR has 10 years of experience with counterpulsation in 209 patients with acute cardiac insufficiency. The main indications for assisted circulation were cardiogenic shock in 102 patients, myocardial infarction complicated by cardiac insufficiency in 43, cardiac insufficiency developing during or after cardiosurgical operations in 60 cases, prophylaxis of complications in high risk patients during intracardiac methods of investigation in 4 cases. The use of counterpulsation in 102 patients with post-infarction cardiogenic shock enabled the authors to liquidate the shock in half of the cases and to discharge 20% of the number from hospital. The study of peculiarities of shock enabled the authors to trace measures for decreasing mortality rate: use of counterpulsation as early as possible during transportation to hospital (29 cases), extension of indications for urgent surgery on the heart.
Subject(s)
Assisted Circulation/methods , Shock, Cardiogenic/therapy , Cardiac Glycosides/therapeutic use , Cardiac Output/drug effects , Heart Block/therapy , Heart Rupture/complications , Heart Rupture/therapy , Hemodynamics , Humans , Myocardial Infarction/complications , Myocardial Infarction/therapy , Pulmonary Edema/therapy , Shock, Cardiogenic/etiology , Time FactorsABSTRACT
The results of treatment of myocardial infarction complicated by cardiogenic shock by-means of arterial counterpulsation and that with an intra-arterial ballon are presented. In order to determine the indications for counterpulsation the authors introduce a classification of cardiogenic shock that takes into account the reactivity of the patient and the speed of decompensation of the systemic circulation. Both methods of counterpulsation permitted to reverse the cardiogenic shock in 81.8% of the cases. In 18.2% the shock appeared to be areactive in nature, 15.9% of the patients died due to a recurrence of the cardiogenic shock after it had been reversed by means of assisted circulation. Other complications of myocardial infarction caused the death of 43.3% of the rest. Hospital mortality comprised 77.4%. The main factors that determine the stable positive countershock effect of counterpulsation in myocardial infarction cases complicated by cardiogenic shock include early introduction of counterpulsation into the set of therapeutic and resuscitation measures, high capacity of assisted circulation devices (up to 31/min.), long duration of continuous counterpulsation (not less than 12 hours).
