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Hemodynamic determinants of cardiogenic shock
Author(s) -
Misra S. N.,
Stanley E. L.,
Kezdi P.
Publication year - 1970
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.2930020309
Subject(s) - cardiogenic shock , medicine , hemodynamics , cardiology , myocardial infarction , shock (circulatory) , stroke volume , contractility , cardiac output , anesthesia , heart failure , ejection fraction
Eighteen healthy mongrel dogs were continuously monitored after induction of myocardial infarction and shock by selective injection of 0.2 ml of metallic mercury into the circumflex branch of the left coronary artery. Seven of the dogs expired within 48 h. Among the rest, the longest survival was 11 days, with an average of 5 days. Left ventricular d P/dt max. was the best parameter in differentiating the severity of shock in these two groups of dogs. The decrease of d P/dt was significantly greater over the period of monitoring in the expired dogs, indicating a marked depression of myocardial contractility as the cause of their death. These dogs also had a larger infarct weight at postmortem. By the fourth hour of monitoring, 40% decrease in d P/dt max., along with similar changes in cardiac output and stroke volume, helped in early diagnosis of pump failure in the expired animals. In contrast, the surviving animals showed in all the hemodynamic parameters a distinct trend of improvement by the fifth hour. Therefore, measurement of left ventricular pressure is important in early diagnosis and prognosis in cardiogenic shock. Based on these observations, we have proposed a plan for institution of therapy in cardiogenic shock. The significance of these observations is discussed.