Shock in acute myocardial infarction: evolution of physiologic therapy.

In the past 25 years the treatment of shock in myocardial infarction has evolved into a physiologic approach based on on-line measurements of hemodynamic variables. This has aided in the development of new pressor agents so that a family of pharmacologic agents is now available. Appropriate use of vasodilators and recognition and treatment of intravascular volume depletion have increased survival. Recognition and appropriate treatment of the preshock state have decreased the incidence of shock. The criteria for use of mechanical support and surgical intervention are soundly established; the use of thrombolytic therapy and balloon angioplasty for this syndrome is ready to be evaluated.