ECG with ST elevation , low BP. Best line of management is-
Ans. is 'c' i.e.. Reperfusion therapy Medical managemento Initial therapy of cardiogenic shock with M.l. consists of early identification, optimally before frank hypotension is present, and rapid stabilization with correction of metabolic abnormalities.Antiplatelet agentsBeta blockerso Beta blockers and Calcium channel blockers should be withheld in patient with cardiogenic shock. Vasopressorso Vasopressors are recommended for patients with cardiogenic shock.o Although there is no definitive evidence of the superiority ofone vasopressor over another, begin with norepinephrine.IABP (Intra Aortic Balloon pump)o The recommendations for the use of an intraaortic balloon pump (IABP) in patients with acute MI and cardiogenic shock are as follows.o For patients in whom mechanical complications (eg, acute mitral regurgitation or rupture of the ventricular septum) are not present and for whom revascularization is planned, intaaortic balloon pumping is not suggested.o However, for such patients whose hemodynamic parameters and clinical status are rapidly deteriorating while on vasopressor and inotropic support, placement of an IABP is suggested# Deterioration is considered present when the systolic blood pressure is persistently below 80 mmHg, there is a fall urine output or a worsening of mentation, the arterial oxygen saturation is falling, or cardiac arrhythmias (including heart block or ventricular tachycardia or fibrillation) develop or worsen.o The role of IABP is not well studied in the uncommon patient treated with fibrinolytic therapy whose hemodynamic parameters and clinical status are rapidly deteriorating while on vasopressor and inotropic support and for whom transfer to a facility capable of performing urgent revascularization is planned.Reperfusiono All patients with CS complication Ml should undergo an attempt at reoer fusion.o The recommendations for the use of reperfusion therapy in patients with MI complicated by CS are similar to those for most patients with Ml and differ principally in the level of evidence For patients with ST elevation MI, revascularization is recommended as opposed to fibrinolytic therapy.This recommendation requires that diagnostic coronary' angiography be performed within 90 minutes of initial hospital presentation.For those patients who cannot undergo timely coronary angiography fibrinolytic therapy rather than no immediate reperfusion.For patients with mechanical complications, immediate CABG is recommended and attempt at repair of the mechanical defect as opposed to PCI.Treatment options for cardiogenic shock due to left ventricular dysfunctiono General measuresVentilation support to correct hypoxemia and, in part, acidosisOptimize intravascular volumeSodium bicarbonate only for severe metabolic acidosis (arterial pH less than 7.10 to 7.15)AspirinIntravenous heparinPossible glycoprotein Ilb/Illa inhibitor with NSTEMIInsertion of pulmonary> artery cathetero Specific measuresPharmacologic supportSympathomimetic inotropes (eg, dopamine)Norepinephrine (for refractory hypotension)o Mechanical supportIABP, usually combined with percutaneous coronary' intervention or coronary artery' bypass graft surgery or possible thrombolytic therapyNewer devicesLeft ventricular or biventricular assist devicesPercutaneous cardiopulmonary-# bypasso Reperfusion/revascularizationPrimary percutaneous coronary interventionCoronary arteryr bypass graftThrombolytic therapy for patients not receiving PCI in a timely manner.
IABP
Vasopressors
Reperfusion
Thrombolytics
C.V.S.