Wed3November0903PM 5

In cardiogenic shock complicating myocardial infarction, the following interventions are of proven clinical benefit:

True / False

The administration of positive inotropic drugs Correct

Pulmonary artery catheterisation Correct

Intra aortic balloon counter pulsation Correct

Early invasive revascularisation Correct

Thrombolysis Correct

Explanation

The only intervention which has conclusively demonstrated an improvement in outcome following myocardial infarction is early invasive angioplasty or stenting.

Although the other interventions may be required to produce an adequate blood pressure they have failed to demonstrate an improved outcome.

Conservative management with catecholamines is associated with serious limitations, including arrhythmias, increased myocardial oxygen consumption, and inadequate circulatory support. Despite the need for effective mechanical circulatory support for cardiogenic shock following acute MI, current mechanical devices, as tested, have not been demonstrated to improve short- or long-term survival rates.

In contrast to the demonstrated efficacy of thrombolysis in uncomplicated myocardial infarction, in post MI cardiogenic shock, thrombolysis may be harmful.

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