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The Impact of Systemic BP on Coronary Blood Flow and Infarct Size During Reperfusion Therapy for Acute Myocardial Infarction : Refinements Beyond the “Plumbing”

John E. Madias
Author and Funding Information

Affiliations: New York, NY
 ,  Dr. Madias is Professor of Medicine (Cardiology), Division of Cardiology, Elmhurst Hospital Center.

Correspondence to: John E. Madias, MD, Professor of Medicine (Cardiology), Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373; e-mail:madiasj@nychhc.org



Chest. 2004;125(4):1179-1181. doi:10.1378/chest.125.4.1179
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The levels of systemic arterial BP encountered in patients admitted for acute myocardial infarction (AMI) cover the gamut of values from hypertension (↑BP) to hypotension (↓BP). Also, the BP can either remain stable or show significant perturbations during the early phase of AMI. First, ↑BP can only be a manifestation of the clinical syndrome of AMI in patients without a history or evidence for ↑BP at subsequent follow-up. In this scenario, the patients are likely to have had an anterior AMI, have ↑BP, are sweating profusely, and manifest tachycardia, thus displaying the full complement of an autonomic hyperadrenergic state. These clinical features are transient, and BP in such patients is normal at follow-up. Second, BP can be high in patients with AMI and known or just-diagnosed ↑BP; often such a diagnosis can be made with certainty only at follow-up by documenting a persistently elevated BP. Third, BP in patients with an AMI can remain normal throughout the hospitalization, and at follow-up. Fourth, ↓BP can be seen along with evidence of tachycardia, and hypoperfusion of peripheral tissues in patients with cardiogenic shock.12 Some of these patients have ↓BP on admission or their initial BP is normal, prior to the development of ↓BP. Fifth, ↓BP may be observed in patients with inferior AMI and associated right ventricular infarct. In these patients ↓BP is mostly transient if fluids are infused in appropriate amounts, and its occurrence can be even prevented by such action. ST-segment elevation in right-chest ECG leads in patients with an inferior AMI,34 history of ↑ BP, and normal BP early after admission can aid in anticipating impending ↓BP.

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