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 121-1 IV VASODILATORS AND INOTROPIC DRUGS USED IN ACUTE MI) |
| 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 Mechanical circulatory support 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.