CARDIOGENIC SHOCK A THEORIST’S VINEYARD

Abstract

Acute myocardial infarction is cursed with high immediate mortality, the main defiants being dysrhythmias heart failure and shock. The wider appreciation and awareness of the role of dysrhythmias in early sudden dissolution and their appropriate aggressive treatment both in the coronary care units and general medical wards has brought down the mortality rate from 40 percent to 10 percent. The car-

There is another subgroup (Subgroup C) in Type III shock. This includes patients who suffer from mitral incompetence. If mitral incompetence is significant (R.F._—o. 5 or more), the ejection fraction would be severely compromised. The inotropic drugs and volume load would considerabl3r aggravate the regurgiatnt fraction making further inroads and encroachment on the ejection fraction. These patients carry 100 percent mortality; their treatment should be similar to that for type III subgroup B except that they would also need mitral valve replacement, a heroic measure indeed though the only hope in this desperate situation with no prospects of survival