(BQ) Part 2 book “ABC of interventional cardiology” has contents: Interventional pharmacotherapy, non-coronary percutaneous intervention, new developments in percutaneous coronary intervention, percutaneous interventional electrophysiology, interventional paediatric cardiology, and other contents. | 7 Percutaneous coronary intervention: cardiogenic shock John Ducas, Ever D Grech Cardiogenic shock is the commonest cause of death after acute myocardial infarction. It occurs in 7% of patients with ST segment elevation myocardial infarction and 3% with non-ST segment elevation myocardial infarction. Cardiogenic shock is a progressive state of hypotension (systolic blood pressure 10 mm Hg and > 80% of pulmonary capillary wedge pressure x Right atrial prominent Y descent x Right ventricle shows dip and plateau pattern of pressure x Profound hypoxia with right to left shunt through a patent foramen ovale x ST segment elevation in lead V4R Main indications and contraindications for intra-aortic balloon pump counterpulsation Indications x Enhancement of coronary flow x Cardiogenic shock after succesful recanalisation by x Unstable and refractory angina percutaneous intervention x Cardiac support for high risk x Ventricular septal defect and percutaneous intervention papillary muscle rupture after x Hypoperfusion after coronary myocardial infarction artery bypass graft surgery x Intractable ischaemic x Septic shock ventricular tachycardia Contraindications x Severe aorto-iliac disease or x Severe aortic regurgitation peripheral vascular disease x Abdominal or aortic aneurysm Catheter tip Central lumen Balloon membrane Catheter Sheath seal Suture pads Management The left ventricular filling volume should be optimised, and in the absence of pulmonary congestion a saline fluid challenge of at least 250 ml should be administered over 10 minutes. Adequate oxygenation is crucial, and intubation or ventilation should be used early if gas exchange abnormalities are present. Ongoing hypotension induces respiratory muscle failure, and this is prevented with mechanical ventilation. Antithrombotic treatment (aspirin and intravenous heparin) is appropriate. Supporting systemic blood pressure Blood pressure support maintains perfusion of vital organs and slows or reverses the .
