title: Cardiogenic shock after acute coronary occlusion. Pathogenesis, early diagnosis, and treatment.
abstract: The early natural history of left anterior descending coronary artery (LAD) occlusion and the development of cardiogenic shock was studied in 35 open chest anesthetized dogs observed for 6 hours. Six control dogs underwent LAD isolation without occlusion, 13 underwent isolated LAD occlusion to simulate single vessel disease, and 14 underwent LAD occlusion and a 50% left circumflex coronary artery (LCA) stenosis to stimulate multi-vessel disease. Control dogs undergoing anesthesia showed no significant changes in hemodynamics after 6 hours. All dogs with single vessel disease survived and developed immediate and persistent dyskinesis of the anterior wall, a compensatory hypercontractility of remote muscle (131% of control)*, slight energy and substrate depletion and anaerobic metabolism (increased G6P)* despite maintenance of "normal" blood flow through the LCA. In contrast, early mortality was 57% in simulated multi-vessel disease as intractable ventricular fibrillation and/or cardiogenic shock caused the deaths of 7 of 13 dogs (57%)*. Remote muscle became progressively hypocontractile (61% of control)* and caused progressive reduction in stroke work index (less than or equal to 0.5 g x m/kg)*. Remote muscle showed moderate substrate and energy depletion (greater than or equal to 60% fall of ATP and CP, 37% fall of glutamate)* and more pronounced evidence of anaerobic metabolism (G6P rose 373%)* despite "normal" blood flow. These findings suggest that remote muscle is the principle determinant of mortality after an otherwise non-lethal cardiac event.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Thoracic- and Cardiovascular Surgery, J.W. Goethe-University, Frankfurt/M., FRG.
authors.forename: F
authors.initials: F
authors.lastname: Beyersdorf
authors.forename: G D
authors.initials: GD
authors.lastname: Buckberg
authors.forename: C
authors.initials: C
authors.lastname: Acar
authors.forename: F
authors.initials: F
authors.lastname: Okamoto
authors.forename: F
authors.initials: F
authors.lastname: Sjöstrand
authors.forename: H
authors.initials: H
authors.lastname: Young
authors.forename: H I
authors.initials: HI
authors.lastname: Bugyi
authors.forename: B S
authors.initials: BS
authors.lastname: Allen
mesh_terms: D000818:Animals; D003326:Coronary Circulation; D003327:Coronary Disease / Q000150:complications*; D004285:Dogs; D004734:Energy Metabolism; D009200:Myocardial Contraction; D009206:Myocardium / Q000378:metabolism; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000209:etiology