Management of Cardiogenic Shock and Rapid Decision-Making

February 22, 2018

Dr. Jeffrey Fowler presents a case involving difficult decision-making. This 86 year old patient was otherwise healthy, but presented with afib with RVR and concern for pneumonia. A bedside echo showed a depressed EF and the cath lab was activated for concern for MI due to troponin. The team found significant, critical left main disease.

Due to mixed cardiogenic and septic picture, TIMI 3 flows in all territories, and likely significant demand ischemia in the setting of Afib/RVR, the team made the decisions to place a balloon pump, treat the patient with antibiotics, and get a blood culture, before making a decision on revascularization. However, the patient’s blood pressure began to drop and filling pressures began to elevate and he required pressors. The team then did a re-evaluation of the plan, implanted the Impella® heart pump for hemodynamic support, and perform a complete revascularization.

Tune in to learn about rapid decision-making during this successful case.

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