Thursday, June 23, 2011

A Case of Anterior wall MI with Septal rupture.

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?
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