Shock is an acute myocardial infarction is usually due to left ventricular dysfunction.It may also due to infarction of the right ventricle and a variety of mechanical complication,including tamponade,an acquired ventricular septal defect and acute mitral regurgitation. Severe myocardial systolic dysfunction causes a fall in cardiac output,blood pressure and by coronary perfusion pressure.Diastolic dysfunction causes a rise in left ventricular end diastolic pressure,pulmonary congesion and oedema,leading to hypoxia that further worsens myocardial ischemia.

Clinical features of miocardial infarction: Prolong cardiac pain Sweating Nausea,vomiting Tachycardia Gallop rhythm Hypotension Oliguria. Investigation: ECG,cardiac biomarker,echocardiogram,chest x-ray,complete blood count,ESR,lipid profile. Management: First ECG and cardiac biomarker then CCU. Analgesic: Morphin sulphate Antiplatelate drug(To prevent thrombosis): Aspirin(300mg)+Clopidogrel+600mg). Then treatment depend on ECG and presentation of patient at time mainly 6-12 hours. If ST elevation MI: Reperfusion therapy is given if the patient come as early as possible which is within 12 hours ,better in within 6 hours.

It includes: Percutaneous intervention Streptokinase/Tissue plasminogen activators. If non ST elevation MI: Anticoagulent therapy,low molecular weight heparin. Complication of MI: Immediate: Arrythmia Acute circulatory failure. Rupture of the papillary muscle and interventricular septum. Pericarditis. Thromboembolism. Late complication: Ventricular aneurysm, dresslar syndrome,post infarc ischemia.