Acute Myocardial Infarction and Hemodynamic Instability

Background: acute myocardial infarction with hemodynamic instability. Aim of the study: To assess the incidence of hemodynamic instability, factors associated with it, and in-hospital outcome among AMI patients. Patients and methods: A case control study of 500 patients with AMI, of them 100 patients have AMI with hemodynamic instability and 400 have AMI with no hemodynamic instability. A number of 345 males and 155 females were included in this study, and their ages ranged between 26 and 87 years. The data was recruited from the emergency department of AI-Yarmook teaching hospital and Ibn Al Nafees teaching cardiovascular hospital between March 2024 and March 2025. All patients diagnosed to have AMI were included in the study; for all of them, we take history, do examination, investigations, ECG, cardiac 24-hour monitoring, CXR, and echocardiography. Results: We found that hemodynamic unstable females were more than those who were stable, while in males, hemodynamic stable patients were more than hemodynamic unstable patients. The percentage of males that develop AMI was more than that of females in both groups. Age range was higher in hemodynamic unstable patients. the presence of risk factors (D.M, HPT, hx of IHD, hx of H.F, family hx of IHD) were more common in hemodynamic unstable patients than hemodynamic stable patients, while (hyperlipidemia, and smoking) were more common in hemodynamic stable patients. Anterior wall MI and double wall (multiple infraction sites) was more common in hemodynamic unstable patients; in contrast, inferior wall MI and other types were more common in hemodynamic stable patients. Dysrrhythemia (tachyarrhythmia and bradyrrhythmia) was more common in hemodynamic unstable patients. The ventricular premature beats were the most common type of tachyarrhythmia in both groups. Patients that have no pulmonary congestion until discharge were more common in the hemodynamic stable group, while the development of pulmonary congestion and cardiogenic shock was more common in hemodynamic unstable patients; the mortality rate was higher in hemodynamic unstable patients. Hemodynamic stable patients receive thrombolytics more than hemodynamic unstable patients do; most of the hemodynamic unstable patients were candidate for primary PCI. All hemodynamic unstable patients develop complications, while most of hemodynamic stable patients do not. All post-AMI complications were more common in hemodynamic unstable patients. The patients that develop hemodynamic instability in the 1st 24 hours were more than those who developed it after that. Conclusion: Hemodynamic instability complicating AMI carries high morbidity and mortality, mandating intensive monitoring and management that includes invasive hemodynamic monitoring and early coronary revascularization