TY  - CHAP
M1  - Book, Section
TI  - Cardiogenic Shock and Intra-aortic Balloon Pump
A1  - Topalian, Simon K.
A1  - Parrillo, Joseph E.
A2  - Lee, Kiwon
Y1  - 2012
N1  - 
T2  - The NeuroICU Book
AB  - A  69-year-old  man  who  has  hypertension  and  diabetes  mellitus  had  a  motor  vehicle  accident  and  suffered  head  trauma.  He  had  a  brief  loss  of  consciousness.  After  evaluation  in  the  emergency  department,  he  was  admitted  to  the  neurology  intensive  care  unit  (ICU)  for  observation.  The  night  of  the  admission,  he  developed  severe  substernal  chest  pain  and  quickly  became  diaphoretic.  His  blood  pressure  was  95/63  mm  Hg,  with  a  pulse  rate  of  60  bpm.  He  was  in  moderate  distress  and  looked  pale  and  clammy.  The  12-lead  electrocardiogram  (ECG)  showed  acute  inferolateral  ST-segment-elevation  myocardial  infarction  (STEMI)  (Figure  34-1).After  consultation  with  the  cardiologist,  the  patient  was  taken  directly  to  the  cardiac  catheterization  laboratory  for  emergent  coronary  angiography  and  angioplasty.  This  showed  a  total  occlusion  of  a  dominant  proximal  left  circumflex  (LCX)  artery  that  was  successfully  opened  with  aspiration  thrombectomy  and  stenting  (Figure  34-2A,  B).  Left  ventriculography  showed  a  severe  inferior  and  lateral  wall  hypokinesis  with  an  ejection  fraction  of  30%.The  patient  remained  hypotensive  despite  being  administered  dopamine  at  10  μg/kg  per  minute.  Right  heart  catheterization  revealed  a  pulmonary  capillary  wedge  pressure  of  28  mm  Hg  and  a  cardiac  index  of  1.8  L/min  per  m2.At  this  point,  an  intra-aortic  balloon  pump  (IABP)  was  placed  and  the  patient  was  transferred  back  to  the  ICU.  His  blood  pressure  remained  stable.  The  dopamine  was  weaned  off  after  several  hours  and  the  IABP  was  discontinued  24  hours  later.  His  echocardiogram  showed  severe  hypokinesis  of  the  inferior  and  lateral  wall.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - neurology.mhmedical.com/content.aspx?aid=1101644899
ER  -