Hemodynamic analysis of cardiac function in patients with acute myocardial infarction
Pillegi, F.; Bellotti, G.; Galiano, N.; Ramires, J.A.; de Moraes, A.V.; Lage, S.G.; Barchi, C.A.; Décourt, L.V.
Arquivos Brasileiros de Cardiologia 35(2): 111-118
1980
ISSN/ISBN: 0066-782X PMID: 7213088 Document Number: 163194
Using bedside hemodynamic monitoring, left ventricular pump function (LV) was analyzed in 80 patients [70 male and 10 female] with acute myocardial infarction (AMI). Ages ranged from 29-76 yr (mean of 58.9 yr). In 46 patients the AMI was in the anterior wall and in 34 the inferior wall. The delay between the precordial pain and the study ranged from 30 min to 96 h (mean of 10 h). The LV pump function analyzed the relationship between diastolic pulmonary arterial pressure [DPAP], the cardiac index (CI) (group A) and LV stroke work (LVSW) (group B). The accepted limit values were 2.2 l/min per m2 for CI, 30 g-m/m2 for LVSW and 17 mmHg for DPAP. Four hemodynamic subsets were identified. In subset H1, group A, the values of CI and DPAP were 2.73 .+-. 0.45 l/min per m2 and 12.21 .+-. 3.37 mmHg, respectively. In group B, the values of LVSW and DPAP were 47.71 .+-. 10.15 g-m/m2 and 12.90 .+-. 3.85 mmHg. In this subset, there was no mortality. In subset H2, group A, the values of CI and DPAP were 2.73 .+-. 0.46 l/min per m2 and 12.21 .+-. 3.37 mmHg, respectively. In group B, the values of LVSW and DPAP were 38.69 .+-. 69 g-m/m2 and 21.31 .+-. 3.35 mmHg. The mortality observed in group A was 25% and occurred in patients with heart rate and DPAP above the maximum value of this subset, with LVSW less than 30 g-m/m2. In subset H3, group A, the values of CI and DPAP were 1.68 .+-. 0.34 l/min per m2 and 9.69 .+-. 3.53 mmHg, respectively. In group B, the values of LVSW and DPAP were 22.0 .+-. 5.51 g-m/m2 and 11.13 .+-. 2.30 mmHg. There was 1 mortality (16.2%). In subset H4, group A, the values of CI and DPAP were 1.65 .+-. 0.33 l/min per m2 and 23.69 .+-. 5.02 mmHg, respectively. In group B, the values of LVSW and DPAP were 18.31 .+-. 6.53 g-m/m2 and 25.62 .+-. 5.75 mmHg. The mortality in this subset was 53%. The analysis of the results permitted the characterization of the importance of bedside hemodynamic monitoring in patients with AMI in the evaluation of the heart pump function; in the observation of 4 hemodynamic subsets with different prognosis; in the identification of patients with hypovolemia, after right ventricular ischemia; and in the observation of the patients classified in clinical or hemodynamic groups as benign.