HEMODYNAMIC MONITORING AND SHOCK

Case #3 Answers:

Answer 1

	Acute MI	Acute PE
a. P_CWP	high	low
b. CO	low	low
c. SVR	high	high
d. PVR	nml	high
e. MVpO₂	low	low
f. P_RA	high	high
g. RV	high	high
h. P_PA	high	high

Answer 2
Emphasize the significant challenges associated with resuscitation of cardiogenic shock in that each of the common modalities have predictable negative consequences.

a. Fluids

Increasing Pcwp may improve preload but…
May result in pulmonary edema

b. Norepinephrine and/or Dopamine

Increasing mean arterial pressure is the goal however….
Increasing afterload increases myocardial work and may reduce cardiac output.

c. Dobutamine and/or Milrinone

Increasing cardiac output is good however…..
Increasing myocardial work in the setting of ischemia is obviously detrimental

d. What other options would you consider?

Revascularization via:
- CABG
- percutaneous angioplasty +/- stenting
- thrombolytics
Intra-Aortic Balloon Pump