Elective surgery after recent MI
so you get an elective non-cardiac surgery case (intraabdominal), whose patient literally had a full inferior STEMI last week (troponin>2), became bradycardic & cardiogenic shock and ended up in ICU intubated on Dopa & Epi gtt. Echo showed mild global hypokinesis EF 45%, but cath showed diffused vasospasm without significant CAD. She recovered, echo normalized, and barely got discharged. Cardiologist said, well, since she doesn't have CAD and MI was purely due to vasospasm, OK to proceed... Elective surgery after recent MI (Source: Student Doctor Network)
Source: Student Doctor Network - June 5, 2019 Category: Universities & Medical Training Authors: Gasper Tags: Anesthesiology Source Type: forums
Cardiogenic shock and intubation
I’m an Emergency Physician that ran into this situation a few months back and that luckily had a good outcome but would like an anesthesiologist’s take on the matter. I had a STEMI patient come in in late one night in massive cardiogenic shock from presumed LV pump failure. SBP in the 60’s. Luckily the patient was awake (impressively enoug) and alert with no airway issues and with Interventional Cardiology maybe 5 minutes out. I was giving a careful fluid bolus and had levophed ready and... Cardiogenic shock and intubation (Source: Student Doctor Network)
Source: Student Doctor Network - February 17, 2018 Category: Universities & Medical Training Authors: Rendar5 Source Type: forums
An end to the routine use of manual thrombectomy in STEMI?
Earlier this month the results of long awaited TOTAL trial were presented at the ACC meeting and simultaneously published in NEJM. TOTAL is the largest randomised trial to date which investigated the routine upfront manual thrombectomy with PCI alone in STEMI. 10,732 patients with STEMI undergoing primary PCI were randomised. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days. The key safety outcome was stroke within 30 days. Manual aspiration thrombectomy was associated with lower rates of incomple...
Source: Doc2Doc BMJ Cardiology - March 26, 2015 Category: Cardiology Authors: Heart Matters Source Type: forums