Question of the Week # 256

256)  A 72 year old man with history of Diabetes Mellitus is rushed to the emergency room by the EMS 30 minutes after he collapsed at his home with severe left sided chest pain. Upon arrival, the patient was found to have very low blood pressure at 70/40 mm Hg.  Chest examination revealed diffuse coarse crepitations. An electrocardiogram showed ST elevations in the anterior leads with reciprocal depressions. The patient was immediately started on Aspirin, GP IIb/IIIA inhibitors, Clopidogrel and Heparin. He is placed on 50% 02 by Venturi mask and his oxygen saturation on this supplemental oxygen is 92%. A diagnosis of cardiogenic shock and pulmonary edema is made and the patient is admitted to intensive care unit. If performed immediately, which of the following interventions would most likely reduce his risk of death?

A)     Thrombolytic therapy

B)     Dopamine infusion

C)      Intra-Aortic Balloon Pump (IABP)

D)     Percutaneous Coronary Intervention

E)     Left Ventricular Assist Device (LVAD)


17 Responses

  1. ddddddddddddd

  2. E

  3. D

  4. it’s obviously D , cuz the patient had ant. MI and Need emerygency PCI

  5. I think believe it is Dopamine, since the patient is in a shock with low blood pressure.

  6. 1st stabilise by B then think about D if within time limit or go for A

  7. why not A since it’s been only 30 mins??

  8. C) Intra-Aortic Balloon Pump (IABP)

  9. C) Intra-Aortic Balloon Pump (IABP)
    then you do the angio
    balloon is life saving in cardiogenic shock

  10. C….Cardiogenic shock is characterized by end-organ tissue hypoperfusion, which initiates a series of counter-regulatory mechanisms. The classic understanding of the interplay between the underlying pathophysiology and counter-regulatory mechanisms is that of a downward spiral in which compensatory mechanisms such as peripheral vasoconstriction, tachycardia, and neurohormonal regulatory activation contribute to further worsening of left ventricular failure.

  11. Answer D

    The window to PCI is <90 min from admission for optimum effect . Since patient is rushed to the hospital after 30 mins . Assummed 90 mins have not passed .

    Which also means this is an EARLY onset shock . And patient wil benefit from PCI

    The question said What decrease MORTALITY : among the choices , only PCI decreased mortality for this patient at this moment .

    PCI is definitely more SUPERIOR than thrombolytics . If there's contraindication or the window to PCI has passed , thrombolytics wil be the answer .

    If the question said what will you do next , then it's Intraoartic balloon pump .

    Cause in ordre to do PCI , you need to do cardiac cath . Is that right . Do correct me if I'm wrong .

    here's a good algorithm i found useful

    Just my 2cents . thanks

  12. D) The use of intraaortic balloon counterpulsation did not significantly reduce 30-day mortality in patients with cardiogenic shock complicating acute myocardial infarction for whom an early revascularization strategy was planned. (Funded by the German Research Foundation and others; IABP-SHOCK II number, NCT00491036.)

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