[Cardiogenic shock in acute myocardial infarct]

Cardiogenic shock is the most important fatal complication of acute myocardial infarction (AMI). This syndrome may be considered as a severe form of left ventricular failure and the mortality rate is very high. According to the clinical classification, Killip class IV ranges from 60 to 95%, depending on authors. Shock occurs in about 15-20% of patients with AMI and accounts for at least 70% of the in-hospital deaths. During 1994, 168 patients with AMI were treated at the Intensive Care Unit of the Zagreb General Hospital, of which 14 (8.2%) developed cardiogenic shock. Ten patients experienced the first myocardial infarction, and 4 were admitted because of the second myocardial infarction, that time of anterior localization. Signs of cardiogenic shock were present in 8 (57.1%) patients already on admission. Three patients developed cardiogenic shock during the first 10 hours of hospitalization and further 3 patients during the initial 4 to 15 days of treatment. Older age prevailed. Eleven (78.5%) persons were older than 60 years of age. Eight patients demonstrated anterior infarction, 4 had inferior infarction and 2 non-Q-wave infraction. All patients had signs of left ventricular failure evidenced by pulmonary edema (Killip class IV) and later complicated by arrhythmia. Of the 14 patients who had AMI with the shock syndrome, 13 (92.8%) died; 5 (35.7%) patients during the first 2 hours, 3 (21.4%) within 24 hours of infarction, and 5 (35.7%) patients during the initial 4 to 25 days of treatment. Patients were treated conservatively, and only 3 patients received thrombolytic therapy, namely, streptokinase.