La insuficiencia cardiaca por disfunción ventricular es una de las peores complicaciones del infarto agudo de miocardio, pues aumenta de 2 a 10 veces su mortalidad. En su fisiopatología intervienen, además de la pérdida muscular, la isquemia y el aturdimiento miocárdico, potencialmente reversibles, la activación neurohormonal, el proceso de remodelado ventricular y fenómenos de inflamación. Para su tratamiento es importante conocer bien los fármacos de que disponemos y sus indicaciones en el contexto del infarto agudo de miocardio, así como el correcto control hemodinámico del tratamiento. En todos los casos es primordial tratar los factores agravantes y desencadenantes de la insuficiencia cardiaca, la hipoxemia y la acidosis, y realizar una estrategia terapéutica guiada por el tiempo de evolución del infarto y la presencia de congestión pulmonar, hipotensión arterial o hipoperfusión periférica. Por último, se hace especial hincapié en la eficacia de la reperfusión coronaria en estos pacientes y en el tratamiento del shock cardiogénico y del infarto de ventrículo derecho.
Palabras clave
Insuficiencia cardiaca
Infarto de miocardio
Shock cardiogénico
Este artículo solo puede leerse en
pdf
Bibliografía
[1.]
F. Van de Werf, D. Ardissino, A. Betriu, D.V. Cokkinos, E. Falk, K.A. Fox, et al.
Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology.
Eur Heart J, (2003), 24 pp. 28-66
[2.]
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with acute myocardial infarction) 2004. Disponible en: www.acc.org/clinical/guidelines/stemi/index.pdf
[3.]
M.S. Nieminen, M. Bohm, M.R. Cowie, H. Drexler, G.S. Filippatos, G. Jondeau, et al.
Guías de práctica clínica sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda. Version resumida.
Rev Esp Cardiol, (2005), 58 pp. 389-429
[4.]
T. Killip, J. Kimball.
Treatment of myocardial infarction in a coronary care unit. A two years experience with 250 patients.
Am J Cardiol, (1967), 20 pp. 457-464
[5.]
J.S. Forrester, G. Diamond, K. Chatterjee, H.J. Swan.
Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts).
N Engl J Med, (1976), 295 pp. 1356-1362
[6.]
T.P. Dormans, J.J. Van Meyel, P.G. Gerlag, Y. Tan, F.G. Russel, P. Smits.
Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion.
J Am Coll Cardiol, (1996), 28 pp. 376-382
[7.]
N.P. Hamlin, J.T. Willerson, H. Garan, W.P. Powell Jr.
The neurogenic vasoconstrictor effect of digitalis on coronary vascular resistance.
J Clin Invest, (1974), 53 pp. 288-296
[8.]
B.I. Jugdutt.
Nitrates in myocardial infarction.
Cardiovasc Drugs Ther, (1994), 8 pp. 635-646
[9.]
J.G. Reves, W. Erdmann, M. Mardis, R.B. Karp, M. King, W.A. Lell.
Evidence for existence of intramyocardial steal.
Adv Exp Med Biol, (1977), 94 pp. 755-760
[10.]
ACE Inhibitor Myocardial Infarction Collaborative Group.
Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of individual data from 100 000 patients in randomized trials.
Circulation, (1998), 97 pp. 2202-2212
[11.]
Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure.
Lancet, (1993), 342 pp. 821-828
[12.]
K. Swedberg, P. Held, J. Kjekshus, K. Rasmussen, L. Ryden, H. Wedel.
Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II).
N Engl J Med, (1992), 327 pp. 678-684
[13.]
K. Dickstein, J. Kjekshus, The OPTIMAAL Steering Committee of the OPTIMAAL Study Grup.
Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial.
Lancet, (2002), 360 pp. 752-760
[14.]
M.A. Pfeffer, J.J.V. McMurray, E.J. Velaázquez, J.L. Rouleau, L. Køber, A.P. Maggioni, et al.
Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both.
N Engl J Med, (2003), 349 pp. 1893-1906
[15.]
B. Pitt, F. Zannad, W.J. Remme, R. Cody, A. Castaigne, A. Pérez, et al.
The effect of spironolactone on morbidity and mortality in patients with severe heart failure.
N Engl J Med, (1999), 341 pp. 709-717
[16.]
B. Pitt, W. Remme, F. Zannad, J. Neaton, F. Martínez, F. Roniker, et al.
Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.
N Engl J Med, (2003), 348 pp. 1309-1321
[17.]
R. DiBianco, R. Shabetai, W. Kostuk, J. Moran, R.C. Schlant, R. Wright.
A comparison of oral milrinone, digoxin, and their combination in the treatment of patients with chronic heart failure.
N Engl J Med, (1989), 320 pp. 677-683
[18.]
G.M. Felker, R.L. Benza, A.B. Chandler, J.D. Leimberger, M.S. Cuffe, R.M. Califf, et al.
Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study.
J Am Coll Cardiol, (2003), 41 pp. 997-1003
[19.]
M. Kivikko, L. Lehtonen, W.S. Colucci.
Sustained hemodynamic effects of intravenous levosimendan.
Circulation, (2003), 107 pp. 81-86
[20.]
V.S. Moiseyev, P. Poder, N. Andrejevs, M.Y. Ruda, A.P. Golikov, L.B. Lazebnik, et al.
Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, double-blind study (RUSSLAN).
Eur Heart J, (2002), 23 pp. 1422-1432
[21.]
F. Follath, J.G. Clealand, H. Just, J.G. Papp, H. Scholz, K. Peuhkurinen, et al.
Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial.
Lancet, (2002), 360 pp. 196-202
[22.]
M.T. Slawsky, W.S. Colucci, S.S. Gottlieb, B.H. Greenberg, E. Haueusslein, J. Hare, et al.
Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Study Investigators.
Circulation, (2000), 102 pp. 2222-2227
[23.]
M.S. Nieminen, J. Akkila, G. Hasenfuss, F.X. Kleber, L.A. Lehtonene, V. Mitrovic, et al.
Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure.
J Am Coll Cardiol, (2000), 36 pp. 1903-1912
[24.]
Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico (GISSI).
Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction.
Lancet, (1986), 1 pp. 397-402
[25.]
In-hospital mortality and clinical course of 20,891 patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin. Lancet. 1990; 336:71-5.
[26.]
L. Lee, R. Erbel, T.M. Brown, N. Laufer, J. Meyer, W.W. O’Neill.
Multicenter registry of angioplasty therapy of cardiogenic shock: initial and long-term survival.
J Am Coll Cardiol, (1991), 17 pp. 599-603
[27.]
J.S. Hochman, L.A. Sleeper, J.G. Webb, T.A. Sanborn, H.D. White, J.D. Talley, et al.
Early revascularization in acute myocardial infarction complicated by cardiogenic shock.
N Engl J Med, (1999), 341 pp. 625-634
[28.]
J.S. Hochman, C.E. Buller, L.A. Sleeper, J. Boland, V. Dzavik, T.A. Sanborn, et al.
Cardiogenic shock complicating acute myocardial infarction-etiologies, management and outcome: a report from the SHOCK Trial Registry.
J Am Coll Cardiol, (2000), 36 pp. 1063-1070
[29.]
J.S. Hochman, L.A. Sleeper, H.D. White, V. Dzavik, S.C. Wong, V. Menon, For the SHOCK Investigators, et al.
One-Year Survival Following Early Revascularization for Cardiogenic Shock.
JAMA, (2001), 285 pp. 190-192
[30.]
H.D. White, J.T. Steward, T.A. Sanborn, A.K. Jacobs, J.G. Webb, L.A. Sleeper, et al.
Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock: results from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial.
Circulation, (2005), 112 pp. 1992-2001
[31.]
H. Mueller, S.M. Ayres, E.F. Conklin, S. Giannelli Jr, J.T. Mazzara, W.T. Grace, et al.
The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction.
J Clin Invest, (1971), 50 pp. 1885-1900
[32.]
W.B. Dunkman, R.C. Leinbach, M.J. Buckley, E.D. Mundth, A.R. Kantrowitz, W. Gerald Austen, et al.
Clinical and hemodynamic results of intraaortic balloon pumping and surgery for cardiogenic shock.
Circulation, (1972), 46 pp. 465-477
[33.]
R.M. Prewitt, S. Gu, U. Schick, J. Ducas.
Intraaortic balloon counterpulsation enhances coronary thrombolysis induced by intravenous administration of a thrombolytic agent.
J Am Coll Cardiol, (1994), 23 pp. 794-798
[34.]
E.M. Ohman, B.S. George, C.J. White, M.J. Kern, P.A. Gurbel, R.J. Freedman, et al.
Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction. Results of a randomized trial. The Randomized IABP Study Group.
Circulation, (1994), 90 pp. 792-799
[35.]
T.A. Sanborn, L.A. Sleeper, E.R. Bates, A.K. Jacobs, J. Boland, J.K. French, For the SHOCK Investigators, et al.
Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry.
J Am Coll Cardiol, (2000), 36 pp. 1123-1129
[36.]
G. Van den Berghe, P. Wouters, F. Weekers, C. Verwaest, F. Bruyninckx, M. Schetz, et al.
Intensive insulin therapy in critically Ill patients.
N Engl J Med, (2001), 345 pp. 1359-1367
[37.]
R.J. Heikkila, J. Downs, P. Nikki, I. Vaisanen, A. Viitanen.
Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema.
Am J Cardiol, (1985), 55 pp. 296-300
[38.]
C.A. Kelly, D.E. Newby, T.A. McDonagh, T.W. Mackay, J. Barr, N.A. Boon, et al.
Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema; effects on plasma brain natriuretic peptide concentrations.
Eur Heart J, (2002), 23 pp. 1379-1386
[39.]
J. Masip, A.J. Betbese, J. Paez, F. Vecilla, R. Cañizares, J. Padro.
Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomized trial.
Lancet, (2000), 356 pp. 2126-2132
[40.]
T.L. Biddle, P.N. Yu.
Effect of furosemide on hemodynamics and lung water in acute pulmonary edema secondary to myocardial infarction.
Am J Cardiol, (1979), 43 pp. 86-90
[41.]
V. Menon, J.N. Slater, H.D. White, L.A. Sleeper, T. Cocke, J.S. Hochman.
Acute myocardial infarction complicated by systemic hypoperfusion without hypotension: a report of the SHOCK trial registry.
Am J Med, (2000), 108 pp. 374-380
[42.]
J.S. Hochman.
Cardiogenic shock complicating acute myocardial infarction. Expanding the paradigm.
Circulation, (2003), 107 pp. 2998-3002
[43.]
R.J. Goldberg, J.M. Gore, J.S. Alpert, V. Osganian, J. Groot, J. Bade, et al.
Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988.
N Engl J Med, (1991), 325 pp. 1117-1122
[44.]
R.M. Prewitt, S. Gu, P.J. Garber, J. Ducas.
Marked systemic hypotension depresses coronary thrombolysis induced by intracoronary administration of recombinant tissue-type plasminogen activator.
J Am Coll Cardiol, (1992), 20 pp. 1626-1633
[45.]
V. Dzavik, L.A. Sleeper, T.P. Cocke, M. Moscucci, J. Saucedo, S. Hosat, For the SHOCK Investigators, et al.
Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry.
Eur Heart J, (2003), 24 pp. 828-837
[46.]
S.C. Wong, T. Sanborn, L.A. Sleeper, J.G. Webb, R. Pilchik, D. Hart, For the SHOCK Investigators, et al.
Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry.
J Am Coll Cardiol, (2000), 36 pp. 1077-1083
[47.]
G. Cotter, E. Kaluski, O. Milo, A. Blatt, A. Salah, A. Hendler, et al.
LINCS: L-NAME (a NO synthase inhibitor) in the treatment of refractory cardiogenic shock: a prospective randomized study.
Eur Heart J, (2003), 24 pp. 1287-1295
[48.]
L.J. Dell’Italia, N.J. Lembo, M.R. Starling, M.H. Crawford, R.S. Simmons, J.C. Lasher, et al.
Hemodynamically important right ventricular infarction: follow-up evaluation of right ventricular systolic function at rest and during exercise with radionuclide ventriculography and respiratory gas exchange.
Circulation, (1987), 5 pp. 996-1003
[49.]
J.A. Goldstein, B. Barzilai, T.L. Rosamond, P.R. Eisenberg, A.S. Jaffe.
Determinants of hemodynamic compromise with severe right ventricular infarction.
Circulation, (1990), 82 pp. 359-368
[50.]
J.A. Goldstein, J.S. Tweddell, B. Barzilai, Y. Yagi, A.S. Jaffe, J.L. Cox.
Importance of left ventricular function and systolic ventricular interaction to right ventricular performance during acute right heart ischemia.
J Am Coll Cardiol, (1992), 19 pp. 704-711
[51.]
T.R. Bowers, W.W. O’Neill, M. Pica, J.A. Goldstein.
Patterns of coronary compromise resulting in acute right ventricular ischemic dysfunction.
Circulation, (2002), 106 pp. 1104-1109
[52.]
J.N. Cohn, N.H. Guiha, M.I. Broder, C.J. Limas.
Right ventricular infarction: clinical and hemodynamic features.
Am J Cardiol, (1979), 33 pp. 209-214
[53.]
G.B. Cintron, E. Hernández, E. Linares, J.M. Aranda.
Bedside recognition, incidence and clinical course of right ventricular infarction.
Am J Cardiol, (1981), 47 pp. 224-227
[54.]
R.S. Baigrie, A. Haq, C.D. Morgan, H. Rakowski, M. Drobac, P. McLaughlin.
The spectrum of right ventricular involvement in inferior wall myocardial infarction: a clinical, hemodynamic and noninvasive study.
J Am Coll Cardiol, (1983), 1 pp. 1396-1404
[55.]
S.H. Braat, C. De Zwaan, P. Brugada, J.M. Coenegracht, H.J.J. Wellens.
Right ventricular involvement with acute inferior wall myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances.
Am Heart J, (1984), 107 pp. 1183-1187
[56.]
J. López-Sendón, E. López de Sa, I. González Maqueda, I. Coma-Canella, F. Ramos, F. Domínquez, et al.
Right ventricular infarction as a risk factor for ventricular fibrillation during pulmonary artery catheterization using Swan-Ganz catheters.
Am Heart J, (1990), 119 pp. 207-209
[57.]
J. López-Sendon, I. Coma-Canella, S. Alcasena, J. Seoane, C. Gamallo.
Electrocardiographic findings in acute right ventricular infarction: sensitivity and specificity of electrocardiographic alterations in right precordial leads V4R, V3R, V1, V2, and V3.
J Am Coll Cardiol, (1985), 6 pp. 1273-1279
[58.]
J. López-Sendon, I. Coma-Canella, C. Gamallo.
Sensitivity and specificity of hemodynamic criteria in the diagnosis of acute right ventricular infarction.
Circulation, (1981), 64 pp. 515-525
[59.]
L.J. Dell’Italia, M.R. Starling, M.H. Crawford, B.L. Boros, T.K. Chaudhuri, R.A. O’Rourke.
Right ventricular infarction: identification by hemodynamic measurements before and after volume loading and correlation with noninvasive techniques.
J Am Coll Cardiol, (1984), 4 pp. 931-939
[60.]
I. Coma-Canella, J. López-Sendon.
Ventricular compliance in ischemic right ventricular dysfunction.
Am J Cardiol, (1980), 45 pp. 555-559
[61.]
M. Zehender, W. Kasper, E. Kauder, M. Schonthaler, A. Geibel, M. Olschewski, et al.
Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction.
N Engl J Med, (1993), 328 pp. 981-988
[62.]
H. Bueno, R. López-Palop, E. Pérez-David, J. García-García, J.L. López- Sendon, J.L. Delcan.
Combined effect of age and right ventricular involvement on acute inferior myocardial infarction prognosis.
Circulation, (1998), 98 pp. 1714-1720
[63.]
A.K. Jacobs, J.A. Leopold, E. Bates, L.A. Mendes, L.A. Sleeper, H. White, et al.
Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry.
J Am Coll Cardiol, (2003), 41 pp. 1273-1279
[64.]
P. Steele, D. Kirch, J. Ellis, R. Vogel, D. Battock.
Prompt return to normal of depressed right ventricular ejection fraction in acute inferior infarction.
Br Heart J, (1977), 39 pp. 1319-1323
[65.]
L.J. Dell’Italia, M.R. Starling, R. Blumhardt, J.C. Lasher, R.A. O’Rourke.
Comparative effects of volume loading, dobutamine, and nitroprusside in patients with predominant right ventricular infarction.
Circulation, (1985), 72 pp. 1327-1335
[66.]
M. Ferrario, A. Poli, M. Previtali, L. Lanzarini, R. Fetiveau, P. Diotallevi, et al.
Hemodynamics of volume loading compared with dobutamine in severe right ventricular infarction.
Am J Cardiol, (1994), 74 pp. 329-333
Trabajo subvencionado en parte con una ayuda RECAVA del Instituto de Salud Carlos III.
Copyright ©
2006. Sociedad Española de Cardiología