Blood Lactate/Pyruvate As a Predictor of Shock Development in Acute Myocardial Infarction

Cardiogenic shock is a leading cause of death in patients with acute myocardial infarction (AMI). In a patient with AMI and left ventricular failure, development of lactic acidosis prognosticates a poor outcome. Elevation of lactate level occurs when oxygen delivery to the nutrient capillaries falls below a critical value to maintain cellular aerobic metabolism. Increased metabolic demands, when not met by an increase in cardiac output and oxygen extractions, are associated with the development of lactic acidosis (1,2). Patients with AMI and left ventricular failure are not able to increase cardiac output, especially when exposed to metabolic stress leading to an additional increase in lactic acidosis.