From patients developing cardiogenic shock in the
acute phase of AMI, 10-30% do it in the first 24 hrs 16,20, and
the cardiogenic shock relates to the extensive loss of muscle
mass. In patients developing it after the 1st day, a complex
relationship between necrotic and viable areas accounts
for a sequence of events. The extension, expansion and
aneurysm formation change ventricular volumes and geometry,
increase stress and oxygen consumption by the
myocardium, as well as jeopardize coronary perfusion 21
(tab. I). Observation of Frank-Starling curves in this group
of patients reveals that, for similar left ventricle (LV) filling
pressures, the cardiac index developed is much lower than
in patients without loss of ventricular mass 22. In addition,
there is lower ventricular compliance, so that small eleva-