Question of the Week # 257

257)  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. The patient is placed on Intra-Aortic Balloon Counterpulsation Pump (IABP) and is rushed to cardiac catheterization lab. In which of the following situations, IABP confers more harm than benefit?

A) Acute Mycocardial Infarction (MI) with Cardiogenic Shock

B) Aortic dissection with aortic regurgitation

C) Severe left ventricular failure with pulmonary edema

D)  Post-MI Ventricular Septal Perforation

E) Post-MI Acute Mitral Regurgitation

7 Responses

  1. B
    thanks

  2. b

  3. B, any Aortic insuf. is a contradiction for IABP.

  4. B

  5. bbb

  6. The IABP has the following effects:

    • Increases coronary artery perfusion
    • Increases myocardial oxygen supply
    • Decreases myocardial oxygen demand
    • Decreases myocardial work by reducing afterload
    • Increases blood pressure
    • Decreases Pulmonary artery pressure

    Indications

    The IABP is used in:-

    • Acute left ventricular failure post cardiac surgery
    • Severe unstable angina
    • Cardiogenic shock post myocardial infarction
    • Bridge to cardiac transplantation
    • Stunned myocardium after myocardial infarction

    Contraindications
    • Severe aortic insufficiency
    • Aortic or abdominal aneurism
    • Severe peripheral vascular disease

  7. Answer B

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: