[Hemodynamic investigation, a logical approach to the treatment of acute myocardial infarction].
The prognostic and therapeutic significance of different haemodynamic variables and subsets in acute myocardial infarction are analyzed. Eighty-eight patients underwent bedside catheterization by the Swan-Ganz technique. They were subdivided into 4 groups according to initial mean pulmonary wedge pressure (PWP) and cardiac index (CI). In group I (PWP less than 18 mm Hg; CI greater than 2.21/min/m2) in-hospital mortality was 2%, in group II (PWP less than 18 mm Hg; CI less than 2.21/min/m2), 8%; in group III (PWP greater than 18mm Hg; CI greater than 2.21/min/m2), 25% and in group IV (PWP greater than 18 mm Hg; CI less than 2.21/min/m2), 67%. Group I corresponds to minimal or mild ventricular dysfunction and group IV to severe ventricular failure or shock. In group III, despite a higher CI, mortality was three times that observed in group II, which suggests that in the absence of clinical signs of hypoperfusion and shock a subnormal cardiac index is not detrimental provided it is not accompanied by tachycardia and increased left ventricular end-diastolic pressure. The hemodynamic patterns of acute myocardial infarction are very variable. Bedside monitoring to evaluate short-term prognosis and form a logical approach to medical therapy represents a major advance in coronary care. The mechanical consequences of acute necrosis may be promptly and often effectively treated, the final goal being the preservation of ischemic myocardium.
D000328:Adult; D000368:Aged; D003971:Diastole; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D013223:Statistics as Topic; D013610:Tachycardia / Q000503:physiopathology
L'investigation hémodynamique, approche logique du traitement de l'infarctus myocardique au stade aigu.