Syndromes of Acute Left Ventricular Failure

The syndrome of acute left ventricular failure, mani-festing as pulmonary edema and/or cardiogenic shock, occurs in many different clinical settings, has many dif-ferent causes, and variable treatment strategies. Most commonly it is seen as a complication of acute myo-cardial infarction where loss of myocardial tissue results in ineifective systolic performance of the left ventricle. Urgent percutaneous transluminal coronary angioplasty may have a significant impact on outcome in this setting. 'Other complicating events following myocardial infarc-tion may also precipitate left ventricular failure includ-ing papillary muscle dysfunction and ventricular septal defect. The syndrome of acute left ventricular failure is also commonly seen in patients with chronic congestive cardiac failure whereby myocardial infarction, arrhyth-n & and even minor increases in salt intake can precipi-tate acute decompensation. Other conditions such as fulrninant myocarditis, bacterial endocarditis and dis-ease processes characterized by diastolic dysfunction can all cause acute left ventricular failure. Moreover, cardiac function may be depressed in septic shock by the presence of cardiodepressant factors. In summary, acute left ventricular failure is a syndrome with a di-verse etiology. Specific diagnosis of the particular cause is crucial to appropriate management. From the Cardiomscular Division, University of hlinnesora, hlin-neapolis, hlN. Received Oct 4,1990, and accepted for publication Oa 1 8, l W