Myocardial Infarction with Cardiogenic Shock

MI with Cardiogenic Shock:

1. Swann – Ganz Catheter

2. Intubate Early


Goals of Therapy:

1. Decrease Pulmonary Congestion

2. Increase Cardiac Output


Management:

1. Systolic BP > 100

Decrease Preload & Afterload

Use IV Nitrates (nitroglycerine)

a) Decreases preload

b) Increases contractility

c) Alleviates pain

d) Decreases myocardial ischemia

(Avoid in Bradycardia (<60) or significant tachycardia (>150)
Dose: 10 – 20 mcg/min

Dopamine/Dobutamine
Dose: 5 – 20 mcg/kg/min

2. Systolic BP 70 – 100

Use dopamine and/or dobutamine
Dose : 5 – 20 mcg/kg/min

3. Systolic BP < 70

Cardiac arrest is imminent

Start NE drip (4mg in 250 cc D5)

Dose: 0.5 – 1 mcg/min, Max 30 mcg/min

When SBP reaches 80+, start dopamine 5 – 20 mcg/kg/min

When SBP reaches 90+, start dobutamine in order to reduce demand for dopamine

If everything is unresponsive consider amrinone, loading dose 0.75 mg/kg IV over 3 – 5 mins, then infusion 5 – 15 mcg/kg/min

Always remember the mechanical lesions, when treating MI with cardiogenic shock:

1. Septal/Wall rupture

2. MR secondary to papillary muscle rupture

3. Ventricular aneurysm
Use IABP, and early surgical consult in such cases.