Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

CONCLUSION:The variables that interplay in cases of severe aortic stenosis are what cause these patients to be so difficult to manage, and specific therapies targeted to fix one issue often worsen the effects of another issue. If someone is in respiratory distress, their airway and breathing needs to be secured, either through non-invasive or invasive means. Next, the patient ’s blood pressure needs to be stabilized. Oftentimes the most appropriate agent will be a positive inotrope, with consideration of a vasoactive agent in persistent hypotension. Once a patient is stabilized, determining the extent of damage to their myocardium and a plan for definitive managem ent can then be determined.Smith comment:Supportive care is often overlooked in the management of cardiogenic shock. The work of breathing demands significant cardiac output and thus puts demands on the heart. Mechanical ventilation withparalysis removes up to 50% oxygen demand and can put the heart to rest. I would immediately intubate a patient who is this ill.As for other invasive therapies,intra-aortic balloon counterpulsation (12, 13) appears to work well in non-randomized studies, and this would also make sense: the balloon in the aorta inflates in diastole, increasing diastolic pressure and thus coronary flow. It also deflates during systole, which normally would reduce afterload; however, in the setting of aortic stenosis, the afterload is determined mostly by the valve, not by post-val...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs