Abnormal Ventricular Function

  • S. M. Ayres
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 6)


Segmental ventricular dysfunction associated with acute myocardial infarction (AMI) is the most common form of acute ventricular failure. Pump failure is the most common cause of death in patients with acute myocardial infarction who do not succumb to fatal arrhythmias. Detailed pathologic studies reveal that 37–70% of the left ventricular surface is infarcted in patients hospitalized in coronary care units with shock as the presumed cause of death [1]. The volume of infarcted tissue, rather than its location, determine ventricular function and the ability of the heart to pump adequate amounts of blood to the peripheral circulation. Most patients dying with coronary shock have extremely severe coronary artery disease with extensive involvement of the left coronary artery. In one study, 68% of patients dying with cardiogenic shock had three vessel disease compared to 35% dying with severe heart failure; 80% of both groups had more than 75% occlusion of the left anterior descending coronary artery [2]. Patients dying from AMI without shock, in one study, exhibited well-demarcated infarct zones that comprised less than 30% of the left ventricle while those dying with shock had a ragged edge and contained many damaged cells, suggesting continuation of the ischemic process. These patients and those dying with shock in the absence of AMI had scattered islands of necrosis in both ventricles [3]. These studies allow a general understanding of the pathogenesis of coronary atherosclerosis and its consequences: angina, unstable angina, acute myocardial infarction, chronic congestive heart failure and shock.


Acute Myocardial Infarction Infarct Size Acute Myocardial Infarction Cardiogenic Shock Coronary Blood Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Weber KT, Ratshin RA, Janicki JS, et al (1973) Left ventricular dysfunction following acute myocardial infarction. A clinicopathologic and hemodynamic profile of shock and failure. Am J Med 54: 697–705PubMedCrossRefGoogle Scholar
  2. 2.
    Wackers FJ, Lie KI, Becker AE, et al (1976) Coronary artery disease in patients dying from cardiogenic shock or congestive heart failure in the setting of acute myocardial infarction. Br Heart J 38: 906–910PubMedCrossRefGoogle Scholar
  3. 3.
    Page DL, Caulfield JB, Kastor JA, et al (1971) Myocardial changes associated with cardiogenic shock. N Engl J Med 1971 285: 133–137CrossRefGoogle Scholar
  4. 4.
    Canty JM Jr, Klocke FJ (1987) Reductions in regional myocardial function at rest in conscious dogs with chronically reduced regional coronary artery pressure. Circ Res 61:II107–116Google Scholar
  5. 5.
    Herman MV, Heinle RA, Klein MD, et al (1971) Localized disorders in myocardial contraction. Asynergy and its role in congestive heart failure. N Engl J Med 277: 222–232CrossRefGoogle Scholar
  6. 6.
    Sonnenblick EH, Spiro D, Spotnitz HM (1964) Ultrastructural basis of Starling’s law of heart: Role of sarcomere in determining ventricular size and stroke volume. Am Heart J 68: 336–346PubMedCrossRefGoogle Scholar
  7. 7.
    Frank O (1895) Zur Dynamik des Herzmuskels. Z Bio 32: 370–447Google Scholar
  8. 8.
    Patterson SW, Piper H, Starling EH (1914) The regulation of the heart beat. J Physiol (Lond) 48: 465–513Google Scholar
  9. 9.
    Braunwald E, Ross J, Sonnenblick EH (1968) Mechanisms of Contraction of the Normal and Failing Heart. Boston, Little, BrownGoogle Scholar
  10. 10.
    Sibbald WJ, Calvin, Driedger AA (1984) Right and left ventricular preload and diastolic ventricular compliance: Implications for therapy in critically ill patients. In: Shoemaker WC, Thompson WL, Holbrook PR (eds) Textbook of Critical Care. Saunders Co, PhiladelphiaGoogle Scholar
  11. 11.
    Mueller H, Ayres SM, Giannelli S Jr, et al (1972) Effect of isoproterenol, 1-norepinephrine and intra-aortic counterpulsation on hemodynamics and myocardial metabolism in shock following acute myocardial infarction. Circulation. 45: 335–351PubMedGoogle Scholar
  12. 12.
    Mueller H, Ayres SM, Conklin EF, et al (1971) The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction. J Clin Invest 50: 1885–1900PubMedCrossRefGoogle Scholar
  13. 13.
    Braunwald E (1984) Heart Disease, 2nd edn. Saunders, PhiladelphiaGoogle Scholar
  14. 14.
    Suga H, Sagawa K (1974) Instantaneous pressure-volume relationships and their ratio in the excised, supported canine left ventricle. Circ Res 35: 117–126PubMedGoogle Scholar
  15. 15.
    Watanabe I, Covell JW, Maroko PR, et al (1972) Effects of increased arterial pressure and positive inotropic agents on the severity of myocardial ischemia in the acutely depressed heart. Am J Cardiol 30: 371–377PubMedCrossRefGoogle Scholar
  16. 16.
    Vatner SF, McRitchie RJ, Maroko PR, et al (1974) Effects of catecholamines, exercise, nitroglycerine on the normal and ischemic myocardium in conscious dogs. J Clin Invest 54: 563–575PubMedCrossRefGoogle Scholar
  17. 17.
    Vatner SF, Baig H (1979) Importance of heart rate in determining the effects of sympathomimetic amines on regional myocardial function and blood flow in conscious dogs with acute myocardial ischemia. Circ Res 45: 793–803PubMedGoogle Scholar
  18. 18.
    Maekawa K, Liang C, Hood WB (1983) Comparison of dobutamine and dopamine in acute myocardial infarction. Effects of systemic hemodynamics, plasma catecholamines, blood flows and infarct size. Circulation 67: 750–759Google Scholar
  19. 19.
    Laks H, Rosenkranz E, Buckberg GD (1986) Surgical treatment of cardiogenic shock after myocardial infarction. Circulation 74:II1–11–16Google Scholar
  20. 20.
    O’Neill WO, Timmis GC, Bourdillon PD (1986) A prospective randomized clinical study of intracoronary streptokinase versus coronary angioplasty for acute myocardial infarction. N Engl J Med 314: 812–818PubMedCrossRefGoogle Scholar
  21. 21.
    Rutherford BD, Hartzler GO, McConahay DR, et al (1985) Direct balloon angioplasty during acute myocardial infarction in patients with severely compromised hemodynamics. Circulation 72: I11–308 (Abstract)Google Scholar
  22. 22.
    O’Neill W, Erbel R, Laufer N, et al (1985) Coronary angioplasty therapy of cardiogenic shock complicating acute myocardial infarction. Circulation 72:ííI-309 (Abstract)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • S. M. Ayres

There are no affiliations available

Personalised recommendations