Interventionist treatment of acute myocardial infarction with cardiogenic shock

pp 239-244

Abstract

The case of a 54 year-old white man who was admitted to the CCU two hours after the onset of an acute antero- septal myocardial infarction is presented. After having received 1,500,000 units of intravenous streptokinase, ST segment elevation not previously present appeared in the lateral and inferior leads. The patient's condition deteriorated: acute pulmonary edema and cardiogenic shock ensued. Pharmacological treatment and mechanical respiratory assistance were instituted. An initial improvement was achieved, but 24 hours after admission the clinical setting became critical requiring intra-aortic balloon counterpulsation. At this moment coronary arteriography was performed showing a sub-occluded (TIM I 1) left anterior descending coronary artery immediately distal to the first septal branch and a total occlusion of a well developed obtuse marginal branch. In spite of the prolonged time window, salvage PTCA attempted in both vessels proved successful. Reperfusion produced a progressive hemodynamic improvement and 48 hours later respiratory assistance and counterpulsation were discontinued. Patient was released in good condition 27 days later. No evidence of hypercoagulability was detected at any moment. In this report we wish to highlight the thrombotic occlusion of two coronary arteries within a very short time period and the excellent clinical response to mechanical reperfusion despite the long period of time elapsed.