Improved Survival After Acute Myocardial Infarction Complicated by Cardiogenic Shock With Circulatory Support and Transplantation: Comparing Aggressive Intervention With Conservative Treatment

Cardiogenic shock: treatment

The treatment of cardiogenic shock complicating the acute coronary syndromes consists of medical therapy, percutaneous revascularization procedures, cardiac surgery, and the implantation of devices. Medical therapy is limited to different positive inotropic and vasoactive drugs, without any firm evidence of survival benefit using these drugs. Several new pharmacologic compounds are at different stages of clinical research, but are not yet routinely approved for the treatment of cardiogenic shock. The only evidence-based therapy with proven survival benefit is timely revascularization. Intra-aortic balloon pump counterpulsation maintains its central role as supportive treatment in cardiogenic shock patients. Anecdotal evidence is available about the use of ventricular assist devices, cardiac resynchronization therapy, and emergent heart transplantation.

Use of the Jarvik 2000 Continuous Flow Left Ventricular Assist Device for Acute Myocardial Infarction and Cardiogenic Shock

Several strategies for circulatory support have been successfully utilized as bridges to recovery or transplantation after acute myocardial infarction and cardiogenic shock. We report the novel use of a continuous flow left ventricular assist device (LVAD) for successful recovery and bridging to transplantation in a patient who had massive anterior wall myocardial infarction.