Parkland manual of in-patient medicine : an evidence-based by Jason N Katz; Chetan B Patel; M Kamran Aslam; Parkland

By Jason N Katz; Chetan B Patel; M Kamran Aslam; Parkland Memorial Hospital (Dallas, Tex.); University of Texas Southwestern Medical School at Dallas

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36 Chapter 1 • CARDIOLOGY • LV FWR: maintain cardiac output36 • Emergent surgery is indicated; medical stabilization pending surgery: • • Rapid colloid fluid infusion and dobutamine at 5-10 ␮g/kg/min Limited pericardiocentesis (10-50 mL); if hypotension and low cardiac output persist, repeat If stabilization occurs, start progressive withdrawal of dobutamine; start beta blockers as tolerated with goal systolic of 100-120 mm Hg, concurrent with prolonged rest; avoid increased intrathoracic pressure; serial echocardiography (every 2-3 days if necessary) • May use intra-aortic balloon pump (IABP) to improve hemodynamics and decrease LV afterload • Interventricular septal rupture: reduce LV workload and therefore degree of shunt; immediate vs.

Davis. A. Davis. A. Davis. A. Davis. A. Davis. A. Davis. A. Davis. A. Davis. A. Davis. A. Davis. A. Davis. A. Davis. A. Davis. Acute Coronary Syndromes and Risk Stratification 25 • Mechanical complications of acute MI (see section titled Complications Following Myocardial Infarction) • Cardiogenic shock (see section titled Complications Following Myocardial Infarction) Patient Care Warnings • Beware of post-MI angina • Check posterior leads with ST-segment depressions in V1-3 to rule out true posterior ST-segment elevations • Avoid nitrates and diuretics in patients with right-sided myocardial infarctions; fluids may be useful • Be cautious with beta blockers in patients with decompensated heart failure in the setting of MI; may consider esmolol as a test dose • Therapy in STEMI should not wait for the results of serum biomarkers • Does your patient have aspirin References ➌ 1.

A. Davis. 36 Chapter 1 • CARDIOLOGY • LV FWR: maintain cardiac output36 • Emergent surgery is indicated; medical stabilization pending surgery: • • Rapid colloid fluid infusion and dobutamine at 5-10 ␮g/kg/min Limited pericardiocentesis (10-50 mL); if hypotension and low cardiac output persist, repeat If stabilization occurs, start progressive withdrawal of dobutamine; start beta blockers as tolerated with goal systolic of 100-120 mm Hg, concurrent with prolonged rest; avoid increased intrathoracic pressure; serial echocardiography (every 2-3 days if necessary) • May use intra-aortic balloon pump (IABP) to improve hemodynamics and decrease LV afterload • Interventricular septal rupture: reduce LV workload and therefore degree of shunt; immediate vs.

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