Hemodynamic monitoring in acute myocardial infarction.

The main cause of in-hospital death in patients with acute myocardial infarction is the "power failure syndrome". Hemodynamic monitoring provides precise and current data on the filling and output status of the left ventricle and, when indicated, the right ventricle. The information obtained is used to determine the hemodynamic status more precisely than is possible from conventional clinical assessment. It permits categorization of patients by hemodynamic status; the hemodynamic subset classification of Forrester, Diamond and Swan is a powerful tool in guiding therapy and establishing prognosis in individual patients. In addition to guiding the initiation of therapy, hemodynamic monitoring is useful in the continuing assessment of potent and complex treatment. This therapy is directed at resolving hemodynamic derangements without unfavourably altering the myocardial oxygen supply-demand relationship. Specific clinical indications for hemodynamic monitoring may include confusing or complicated clinical situations in which diagnostic problems exist, complicating mechanical derangements, severe congestive heart failure, cardiogenic shock and clinical research in acute myocardial infarction.     

Value of infarct-specific isotope (99mTc-labelled stannous pyrophosphate) in myocardial scanning.

With the use of 99mTc-labelled stannous pyrophosphate scans positive for myocardial infarction were obtained from 28 patients in the acute stage of the disease. In some cases the scan was positive when the initial electrocardiogram gave equivocal results. Negative scans were obtained from a control group of patients and from eight patients in hospital with chest pain but with no other evidence of recent myocardial infarction.