The management of patients with cardiogenic shock associated with acute myocardial infarction is attended by a high mortality. Recently, measurement of left ventricular filling pressure, either directly by left heart catheterization or indirectly by recording of pulmonary artery diastolic pressure, has been performed and advocated as a guide to therapy.1-3 This communication describes a patient in whom long-term continuous monitoring of pulmonary arterial pressure was useful in determining therapy after rupture of the interventricular septum following an acute myocardial infarction.
A 67-year-old-male physician developed signs of acute left ventricular failure and a grade 4/6 apical holosystolic murmur four days after an acute myocardial infarction. Despite the administration of digoxin and furosemide, heart failure progressed over a ten-day period, and he was transferred to the University Hospital. Physical examination revealed a markedly ill, dyspneic white man with cool moist skin. Blood pressure was 90/60 mm Hg; pulse rate,