The presence of shock in AMI results in a complex spiral relationship. Coronary obstruction leads to myocardial ischemia, which, in turn, impairs myocardial contractility and ventricular outflow. The resulting reduction in arterial blood pressure leads to further decreases in coronary arterial perfusion, resulting in worsening myocardial ischemia and more severe myocardial necrosis. Interruption of this downward spiral requires careful attention to fluid management, preload, afterload, and the Frank-Starling relationships. Resolution of ischemia and preventing or minimizing the area of stunned myocardum that progresses to infarction is imperative.
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