Complicated acute myocardial infarction. Heart failure, shock, mechanical complications.

In-hospital mortality in patients with acute myocardial infarction is predominantly related to heart failure or shock and mechanical complications (acute mitral regurgitation, ventricular septal rupture, and free wall rupture). Heart failure and shock are primarily the consequences of contractile dysfunction of the left ventricle. Use of inotropic agents and assist devices are temporizing measures; early reperfusion with salvage of ischemic interventricular septum or free wall, resulting in severe mitral insufficiency, left to right shunt, and acute tamponade, respectively, necessitates immediate diagnosis and surgical intervention.