Hemodynamic Complications in Acute MI
| Condition | Cardiac Index, (L/min)/m2 | PCW, mmHg | Systolic bp, mmHg | Treatment |
|---|---|---|---|---|
| Uncomplicated | >2.5 | ≤18 | >100 | — |
| Hypovolemia | <2.5 | <15 | <100 | Successive boluses of normal saline |
| In setting of inferior wall MI, consider RV infarction (esp. if RA pressure >10) | ||||
| Volume overload | >2.5 | >20 | >100 | Diuretic (e.g., furosemide 10-20 mg IV) |
| Nitroglycerin, topical paste or IV (Table 119-1) | ||||
| LV failure | <2.5 | >20 | >100 | Diuretic (e.g., furosemide 10-20 mg IV) |
| IV nitroglycerin (or if hypertensive, use IV nitroprusside) | ||||
| Severe LV failure | <2.5 | >20 | <100 | If bp ≥90: IV dobutamine ± IV nitroglycerin or sodium nitroprusside |
| If bp <90: IV dopamine | ||||
| If accompanied by pulmonary edema: attempt diuresis with IV furosemide; may be limited by hypotension | ||||
| If new systolic murmur present, consider acute VSD or mitral regurgitation | ||||
| Cardiogenic shock | <2.2 | >20 | <90 with oliguria and confusion | IV norepinephrine or dopamine Intraaortic balloon pump Reperfusion by PCI or CABG may be life-saving |
Abbreviations: CABG, coronary artery bypass graft; PCI, percutaneous coronary intervention; PCW, pulmonary capillary wedge pressure; RA, right atrium; VSD, ventricular septal defect.