Images in Clinical Medicine
Kim Eagle, M.D., Editor
Emergency Coronary-Artery Angioplasty for Cardiogenic Shock Complicating Acute Myocardial Infarction
N Engl J Med 1993; 328:707March 11, 1993
- Article
Figure 1 Emergency Coronary-Artery Angioplasty for Cardiogenic Shock Complicating Acute Myocardial Infarction.
Coronary-artery angioplasty was performed in a 45-year-old man who presented with two hours of crushing retrosternal chest pain and hypotension (blood pressure, 90/60 mm Hg). Electrocardiography revealed evidence of an acute anterior-wall myocardial infarction. Coronary arteriography (Panel A) showed a left anterior descending artery that was totally occluded in its proximal portion (indicated by the arrow in each panel), with normal right and circumflex coronary arteries. Emergency coronary-artery angioplasty (Panel B) resulted in rapid antegrade flow without residual stenosis at the site of the occlusion (Panel C). The patient's hemodynamic status stabilized, and the rest of his hospital course was unremarkable. An echocardiogram obtained the day after catheterization and angioplasty showed an akinetic anterior wall and an ejection fraction of 20 percent. An exercise test before discharge from the hospital was negative for signs of residual myocardial ischemia. Six weeks after discharge, echocardiography demonstrated an estimated ejection fraction of 50 percent, and a maximal exercise test was negative.
Kim Eagle, M.D.
Harry Feld, M.D.
Maimonides Medical Center, Brooklyn, NY 11219
