Hemodynamic monitoring using the invasive pulmonary artery balloon-tip catheter (PAC) has been the gold standard for evaluation of circulatory function since it?™s introduction in the early 1970s. It allows for measurement of central venous or right atrial pressure, pulmonary artery systolic, diastolic and mean pressures, PAOP or wedge pressure, thermodilution cardiac output and oxygen saturation. Common formulae allow us to calculate further determinants of the cardiovascular system
( e.g. systemic vascular resistance , pulmonary vascular resistance, RV stroke work and LV stroke work). The use of PAC over the past quarter century has fostered major advances in the diagnosis and treatment of patient with acute myocardial infarction.
New cardiac diagnostic and treatment strategies have envolved in the past two decades have placed PAC in a different perspective. Also the safety and impact of PAC on patient outcome have recently been questioned in the medical literatures. So an expert consensus document has been published by ACC in 1988. Recommendations for PAC monitoring and intra-artery pressure monitoring in patients with acute myocardial infarction were also made in 1999 in the AMI Guidelines published by AHA/ACC.
Echocardiography with Doppler imaging is the most important alternative or complementary procedure to PAC in the patient with acute coronary syndromes. A number of echocardiographic methods have been developed to obtain hemodynamic measurement. By using spatial imaging methods, cardiac chamber volumes can be estimated to obtain both preload and stroke volume and hence cardiac output. In addition Doppler based methods can be used to estimated LV filling, pulmonary artery pressure, IVRT and cardiac output. In patients with AMI echocardiography has a primary role in the diagnosis of mechanical complication while PAC is helpful in certain instances for assessment of the severity of hemodynamic compromise and the short-term response to pharmacologic agents and mechanical support.

ˇ@

ˇ@

ˇ@

|| BACK ||