PMID: 1894853Oct 1, 1991

Limitations of thrombolytic therapy for acute myocardial infarction complicated by congestive heart failure and cardiogenic shock

Journal of the American College of Cardiology
E R Bates, E J Topol

Abstract

As many as one quarter of patients treated with thrombolytic therapy present with congestive heart failure or cardiogenic shock. Although thrombolytic therapy has been shown to limit infarct size, preserve left ventricular ejection fraction and decrease mortality in most subgroups of patients, no apparent benefit has been demonstrated in patients with clinical left ventricular dysfunction. The lack of correlation between ejection fraction and other measurements of left ventricular dysfunction such as exercise time, cardiac output, filling pressures, activation of the neurohumoral system and regional perfusion bed abnormalities may partly explain this paradox. Alternatively, lower perfusion rates, higher reocclusion rates, associated mechanical complications or completed infarction may explain these findings. Preliminary data indicate that emergency coronary angioplasty or bypass graft surgery improves survival in selected patients with cardiogenic shock. Because these findings suggest that restoration of infarct artery patency is especially important in patients with clinical left ventricular dysfunction, additional studies are needed in these patients to investigate the potential benefit that new thrombolytic strategies, inotr...Continue Reading

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Related Concepts

Ventricular Dysfunction, Left
Myocardial Infarction
Left Ventricular Function
Coronary Artery Bypass Surgery
Myocardial Reperfusion
Ventricular Dysfunction
Thrombolytic Therapy
Percutaneous Transluminal Coronary Angioplasty
Myocardial Failure
Emergencies [Disease/Finding]

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