A 78 year-old-woman developed sudden-onset, severe chest pain and was brought to the Emergency Department of Apollo Hospital, Chennai. In the Emergency Department she was quickly evaluated and her ECG revealed extensive anterior wall involvement. The patient was taken over by the cardiac emergency response team who confirmed the presence of triple-vessel disease by angiogram. The left anterior descending artery was completely blocked and two other vessels were extensively involved.
TThe Cardiothoracic and Vascular Surgery Department (CTVS) admitted the patient and performed emergency revascularization procedures. A stent was placed in the left anterior descending artery. In the immediate period following the procedure, the patient developed severe hypotension and pulmonary edema. The patient was intubated and an intra-aortic balloon pump was inserted. Further circulatory support was enhanced with inotropes. The patient’s condition improved. On the third day following the procedure, she was extubated and shifted to the ward.
Recent advances in the treatment of acute coronary syndrome have resulted in the overall reduction of mortality following myocardial infarction. Procedures that ensure complete revascularization limit the size of the ischemic myocardium and improve overall outcome. Revascularization procedures include coronary artery bypass grafting and percutaneous coronary intervention. Percutaneous coronary interventions performed for revascularization include intracoronary stents, atherectomy, balloon catheters and thrombus aspiration.
However, patients with multiple-vessel disease have a higher risk of complications following the procedure and less favorable outcome. Some patients undergoing revascularization experience a low cardiac output in the postoperative periods. Intensive treatment is required in such cases due to the high mortality and morbidity.
Intra-aortic balloon pumps (IABP) are mechanical devices that provide circulatory support. The device consists of a balloon which is inserted percutaneously into the descending aorta. Cyclical inflation and deflation of the balloon provides counter-pulsations to a failing myocardium. These pumps improve the myocardial function by reducing afterload and augmenting diastole. These improve the perfusion of vital organs by maintaining afterload. The use of IABP prevents extension of the myocardial infarction and restores coronary blood flow.
Early revascularization has been advocated by several guidelines for the management of acute myocardial infarction. The complications following the procedure are reduced by the use of upgraded devices, stents, and aggressive medical management. IABP is the most frequently used device for circulatory support in cardiogenic shock. The use of IABP is associated with improved survival and reduced hospital stay.
Expertise at Apollo Hospitals
The hemodynamic state of patients with cardiogenic shock is highly unstable and requires close monitoring and immediate interventions. The erudition of Apollo Hospitals has been proven time and again by the way such complicated cases were adeptly managed. Patients with cardiogenic shock are effectively managed by high-tech treatment like coronary stenting and IABP.
Outcome of the Current Patient
This patient had extensive involvement of the myocardium. The initial revascularization procedure was complicated by the development of pulmonary edema and hypotension. However, a grave outcome was averted by the adept management at Apollo Hospitals. The patient was stabilized successfully and is recovering quickly.