A 56 year old man, no previous co-morbidities, is shifted to our tertiary care centre from a nursing home, where he was admitted the evening prior with chest pain of 2 hours duration, sweating and low BP = 80/45 mmHg. ECG demonstrated anterior ST elevation for which he was given aspirin, r-TPA, heparin. His symptoms resolve. Serum chemistries reveal a peak CPK of 1800 and a CK-MB fraction of 15%. He continues to be hypotensive, and his examination reveals a holosystolic murmur. 2D Echo shows a large VSD.
On arrival to our centre, he is conscious, oriented, appears mildly dyspnoeic and BP is recorded 60/35 and his pulse is 112 and regular.
We intubated and ventilated him. Put an Intra-aortic balloon pump, and started ionotropic support at moderate doses and could get the BP up to 72/40 mmHg.
Please give your suggestions. How do you manage this case?
Post your comments and suggestions in the comments below.
On arrival to our centre, he is conscious, oriented, appears mildly dyspnoeic and BP is recorded 60/35 and his pulse is 112 and regular.
We intubated and ventilated him. Put an Intra-aortic balloon pump, and started ionotropic support at moderate doses and could get the BP up to 72/40 mmHg.
Please give your suggestions. How do you manage this case?
Post your comments and suggestions in the comments below.
