The Journal of clinical investigation
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Hemodynamics and myocardial metabolism were evaluated in 18 patients in cardiogenic shock following acute myocardial infarction. The response to l-norepinephrine was studied in seven cases and the response to isoproterenol in four cases. Cardiac index (CI) was markedly reduced, averaging 1.35 liters/min per m(2). ⋯ Myocardial lactate metabolism deteriorated uniformly; lactate production increased or extraction shifted to production. In the acute state of coronary shock the primary therapeutic concern should be directed towards the myocardium and not towards peripheral circulation. Since forward and collateral flow through the severely diseased coronary bed depends mainly on perfusion pressure, l-norepinephrine appears to be superior to isoproterenol; phase-shift balloon pumping may be considered early when pharmacologic therapy is unsuccessful.