Cardiogenic shock in right ventricular infarction managed with a combined thermodilution and pacing pulmonary artery...

When cardiogenic shock complicates right ventricular infarction it is widely appreciated that rational therapy can only be achieved by use of plasma volume expansion and inotropic agents guided by invasive monitoring (Cohn et al., 1974). In these cases, there is a high incidence of symptomatic heart block and serious atrial and ventricular dysrhythmias (Cohn, 1979). Thus, venous access may be required for monitoring, pacing, infusion of fluid, and vasoactive or antiarrhythmic drugs. A case of right ventricular infarction complicated by cardiogenic shock, heart block, multiple arrhythmias and severe hypoxaemic respiratory failure is described. Technical problems in venous access were encountered and overcome by the use of a single multi-purpose catheter for haemodynamic monitoring, infusion of drugs and fluids and passage of a pacing wire. We believe that this is the first description of the use of such a catheter in the United Kingdom, although the use of a multi-purpose pulmonary artery flotation catheter with fixed pacing electrodes has been described before (Zaidan & Freniere, 1983).