A previously healthy 58 years old man is admitted to the hospital because of an acute inferior myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is 90/60 mmHg). Insertion of a pulmonary artery (Swan-Ganz) catheter reveals the following pressures: pulmonary capillary wedge-4 mm Hg; pulmonary artery- 22/4 mmHg: and mean right atrial-11 mmHg. This man would best be treated with:
Ans. is 'a' i.e Fluids Pulmonary Artery pressure - 22/4 mmHgPulmonary Capillary Wedge pressure- 4 mmHgPulmonary artery pressure denotes Right atrial pressure and pulmonary capillary wedge pressure denotes left atrial pressure.The man described in the question most probably has inferior myocardial infarction because right atrial pressure is elevated out of proportion to left atrial pressureCardiac output is depressed on the basis of an insufficient left heart filling pressure. The best treatment consists of administration of fluids.
Fluids
Digoxin
Dopamine
Intraaortic balloon counterpulsation
C.V.S.