Left Ventricular Contraction and the Therapy of Cardiogenic Shock

Ross, John

doi:10.1161/01.cir.35.4.611

Cited by 29 publications

(6 citation statements)

References 9 publications

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“…The electrodes were connected to a switch box which was in turn connected to the V lead of the electrocardiograph. Recordings were made every 4, right), when these indices were compared just before and 15 min after the IABC began. The average ST deoreased from 4.2 + 1.1 to 2.8+1.0 mv (P < 0.01), and the average NST fell from 6.5 ± 1.0 to 3.7 ± 1.4 (P < 0.01), while mean arterial pressure and heart rate did not change significantly (from 108 + 5 to 110 ± 6 mm Hg and from 157 + 11 to 154 ± 10 beats/min).…”

Section: Methodsmentioning

confidence: 99%

Effects of Intraaortic Balloon Counterpulsation on the Severity of Myocardial Ischemic Injury following Acute Coronary Occlusion

et al. 1972

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The effects of intraaortic balloon counterpulsation (IABC) on the magnitude and severity of myocardial ischemic injury were studied in 19 dogs following acute coronary occlusion and in two patients with cardiogenic shock. In the experimental group, epicardial electrocardiograms were taken from 10-14 sites on the anterior surface of the left ventricle following occlusion of the left anterior descending coronary artery or its apical branch. The average S-T-segment elevation (ST) was used as an index of the magnitude of myocardial ischemic injury. In six dogs, two successive 20-min occlusions were performed, and IABC was started prior to the second occlusion. ST 15 min following occlusion decreased from 3.3 + 0.9 mv after the control occlusion to 1.4 0.4 mv (P < 0.01) after the occlusion with IABC. In three dogs in which the occlusion was maintained and IABC initiated 30 min later, ST decreased from 1.2 to 0.6 mv. In six dogs in which IABC was started 3 hours after occlusion, it induced a reduction of ST from 4.2 1.1 to 2.8 1.0 mv (P < 0.01). In four dogs, ischemic injury was augmented by isoproterenol infusion (0.25 ,ug/kg/min), and while continuing the infusion IABC was initiated. It reduced ST from 8.0 + 1.9 to 5.7 1.8 mv (P < 0.05). Thus, IABC reduced the magnitude and extent of myocardial ischemic injury after experimental coronary occlusion, both when IABC was employed prior to, and 3 hours following, coronary occlusion. IABC was also effective in reducing myocardial ischemic injury which had been increased by isoproterenol infusion. Employing a noninvasive technic, which utilizes 35 electrodes on the thorax, the effects of IABC were examined in two patients with cardiogenic shock associated with acute myocardial infarction. Preliminary observations in these patients confirmed the experimental results indicating that IABC reduced myocardial ischemic injury.

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Section: Methodsmentioning

confidence: 99%

Effects of Intraaortic Balloon Counterpulsation on the Severity of Myocardial Ischemic Injury following Acute Coronary Occlusion

et al. 1972

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“…Nevertheless, we believe 1-norepinephrine is the drug of choice in the initial treatment of coronary shock (32,(62)(63)(64)(65)(66)(67)(68) (16,24,69,70). In contrast, in the ischemic and dilated heart, IACP increased coronary blood flow and oxygen consumption (16,24,25 …”

Section: Technique Of Intra-aortic Counterpulsationmentioning

confidence: 99%

The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction

Mueller¹,

Ayres²,

Conklin³

et al. 1971

J. Clin. Invest.

145

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A B S T R A C T The effect of intra-aortic counterpulsation (IACP, 22-94 hr) on hemodynamics and cardiac energetics was evaluated in 10 patients in shock after acute myocardial infarction. The data clearly indicate that IACP improves myocardial oxygenation, enhances peripheral perfusion, and probably improves myocardial contractility in the severely diseased heart.Before treatment, decreases in cardiac index (mean value, 1.22 liter/min per m'), systolic ejection rate (67 ml/sec), and time-tension index per minute (1280 mm Hg -sec/min) were observed. Systemic vascular resistance varied widely. Low coronary blood flow (68 ml/min per 100 g) was associated with increased myocardial oxygen extraction (79%), low coronary sinus oxygen tension (20 mm Hg), and abnormal myocardial lactate-pyruvate metabolism.During 4-6 hr of IACP, systolic pressure and left ventricular outflow resistance decreased by 18% and 24%, respectively, while cardiac index improved by 38%. Diastolic arterial pressure rose 98%. Increase in coronary blood flow from an average of 68 to 91 ml/100 g per min (P < 0.001) was significantly correlated with rise in mean arterial pressure (r = 0.685). This correlation was best expressed in a third-order curve, which intercepts the point of no flow at a mean aortic pressure of 30 mm Hg. The flow-pressure curve is relatively flat above 65-70 mm Hg, but becomes steeper as mean aortic pressure falls below this point. Myocardial oxygen consumption remained essentially unchanged during early IACP and tended to rise during the later stages.However, the relationship of cardiac work performed to oxygen availability was markedly improved. Myocardial

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“…Systemic hemodynamic measurements have been made in acute shock by a number of investigators (2)(3)(4)(5)(6)(7)(8)(9) although coronary shock has not always been clearly separated from other varieties of cardiogenic shock. Iso-proterenol (2,7,(10)(11)(12), l-norepinephrine (3,5,6,8,(12)(13)(14), alpha adrenergic blocking agents (11,12,15), intra-aortic phase-shift balloon pumping (16)(17)(18)(19), and other techniques have been recommended for coronary shock but evidence of their efficacy has been limited to measurements of cardiac output and peripheral vascular resistance.…”

mentioning

confidence: 99%

Hemodynamics, coronary blood flow, and myocardial metabolism in coronary shock; response to l-norepinephrine and isoproterenol

Mueller¹,

Ayres²,

Gregory³

et al. 1970

J. Clin. Invest.

113

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Left Ventricular Contraction and the Therapy of Cardiogenic Shock

Cited by 29 publications

References 9 publications

Effects of Intraaortic Balloon Counterpulsation on the Severity of Myocardial Ischemic Injury following Acute Coronary Occlusion

Effects of Intraaortic Balloon Counterpulsation on the Severity of Myocardial Ischemic Injury following Acute Coronary Occlusion

The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction

Hemodynamics, coronary blood flow, and myocardial metabolism in coronary shock; response to l-norepinephrine and isoproterenol

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