الفهرس 
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Abstract
Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) continues to be a frustrating problem of great clinical significance. With improvements in the medical management of AMI, particularly the treatment of ventricular arrhythmias, CS has emerged as the most common cause of death (7 to 12%) of all patients admitted with myocardial infarction.
Interestingly, despite more aggressive therapeutic interventions in the last decade, the incidence of CS after AMI has remained relatively stable, averaging 7%.
Furthermore, mortality for CS has not decreased significantly, despite intensive medical management including inotropes, thrombolysis, and intraaortic balloon pump (IABP) support, and revascularization, mortality from CS remains in excess of 50%.
Several mechanisms can lead to the development of cardiogenic shock after AMI. The relative incidence of the various causes of CS includes the following:
-Predominant left ventricular (LV) failure (78%).
-Acute mitral valve regurgitation (7%).
-Ventricular septal rupture (4%).
-Acute tamponade/free-wall ruptures (1.5%).
-Isolated right ventricular shock (3%).
-Other causes (6.5%).
This latter group includes cardiac-related diagnoses such as dilated cardiomyopathy, medication excess, and cardiac catheterization complications. It is important to emphasize that the mechanical complications secondary to myocardial rupture (free wall, septum, or papillary muscle rupture) account for the minority of the cases. In the majority of the patients, the cause of death is low cardiac output secondary to predominantly LV failure, which in turn leads to organ failure, arrhythmias, and irreversible shock.
The present study is a descriptive, comprehensive study designed to determine the incidence of cardiogenic shock as the presenting problem in acute MI patients and to outline different factors that may induce cardiogenic shock as an early presentation
The present study included 60 patients presented with acute MI with or without cardiogenic shock; they were selected from the emergency and ICU departments, Al-Agoza hospital.
Both sexes and all ages were included.
Patients with end stage valvular or myocardial disease and other types of shock were excluded.
All the studied patients were subjected to full history taking, complete physical examination, laboratory investigations especially cardiac enzymes, ECG and finally echocardiographic assessment.
Then, all patients were followed up for Major Adverse Cardiac Events (MACE) till their discharge or death. Finally statistical analysis of the collected data was done.
As regards results of the study we found that:
* The incidence of cardiogenic shock as the presenting problem in acute MI was 13.3%.
* The presence of angina pectoris, previous MI, diabetes mellitus and heart failure was significantly higher among patients presenting with cardiogenic shock.
* There was a significantly higher heart rate and lower systemic blood pressure among patients with cardiogenic shock.
* Cardiogenic shock predominates in patients who didn’t receive thrombolytic therapy.
* The location or the type of MI did not show any significant difference in those with and those without cardiogenic shock.
* There was statistically significant increase of all cardiac enzymes in cases with cardiogenic shock in comparison to cases without cardiogenic shock.
* Patients with cardiogenic shock had a significantly lower EF as compared to those presenting with MI without cardiogenic shock.
* Patients with cardiogenic shock stayed more in the hospital with significantly more incidence of reinfarction and in-hospital mortality.
Finally we recommend:
• Larger multicenter study for the incidence of cardiogenic shock and the predisposing factors all over EGYPT.
• Prospective studies that test the effect of different treatment modalities on the incidence and the fate of cardiogenic shock.
• Health education about coronary diseases as regards their risk factors and first aid.
• Supply more facilities to hospitals to manage complications of coronary diseases.
Conclusion
The results of the present study revealed that:
• The Incidence of CS among patients with acute MI was 13.3%
• Cases with CS were older in age, had higher incidence of diabetes mellitus, angina, previous MI and heart failure
• Larger size of infarction, as reflected in increased level of cardiac enzymes, was found in patients with CS.
• Patients with CS stayed longer in the hospital with a higher incidence of in hospital complications and death.