Mukherjee_Interventional Cardiology Board Review, 4e

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Interventional Cardiology Board Review

A. Procainamide B. Lidocaine C. Isoproterenol D. Amiodarone

7.11 Which vasoactive agent is recommended in pa tients with hypertrophic obstructive cardiomyop athy (HOCM) experiencing hypotension? A. Dopamine B. Dobutamine

7.15 A 62-year-old male is transported to the ED after being resuscitated for out-of-hospital cardiac ar rest secondary to an ST-segment elevation myo cardial infarction (STEMI) for which the patient receives a drug-eluting stent (DES) to the proxi mal left anterior descending artery. The patient be comes hypotensive and febrile after percutaneous coronary intervention with BP 88/42 mm Hg and temperature 101.1 °F. A right heart catheterization reveals the following hemodynamic parameters: right atrial pressure 14 mm Hg, PCWP 25 mm Hg, CO 4.9 L/min, cardiac index 2.0 L/min/m 2 , and systemic vascular resistance 702 dynes s/cm 5 . Rel evant laboratory parameters include white blood cell (WBC) count 13.2 cells/mm 3 , serum lactate 4.5 mmol/L, and mixed venous oxygen saturation (SvO 2 ) 60%. Which vasoactive medication is most appropriate to optimize hemodynamics in this patient? A. Dobutamine B. Milrinone C. Epinephrine D. Norepinephrine Her PMH includes hypertension and paroxysmal atrial fibrillation. Home medications include am lodipine 10 mg daily, apixaban 5 mg twice daily, and bisoprolol 5 mg daily. Pertinent physical exam findings include bilateral rales and cool ex tremities bilaterally. Initial vital signs include BP 84/42 mm Hg, HR 109 bpm, RR 24 bpm, SpO 2 90% on bilevel positive airway pressure (BiPAP) ( F io 2 60%), and temperature 99.1 °F. Relevant laboratory parameters include serum creatinine 2.2 mg/dL (baseline 1.1 mg/dL), WBC 8.2 cells/ mm 3 , and lactate 3.9 mmol/L. An ECG shows si nus tachycardia, and a chest x-ray reveals bilateral interstitial opacities. A transthoracic echocardio gram reveals the following: LVEF 55%, AV peak velocity 4.4 m/s, AV mean gradient 42 mm Hg, AV area 0.9 cm 2 , and stroke volume index 48 mL/m 2 . Which vasoactive medication is best to initiate? A. Milrinone B. Dobutamine C. Phenylephrine D. Dopamine 7.16 A 78-year-old female is transported to the ED with dyspnea on exertion and altered mentation.

C. Phenylephrine D. Norepinephrine

7.12 A 59-year-old man is brought to the cardiac cath eterization lab following a positive stress test. Fifteen minutes into the procedure, the patient becomes profoundly hypotensive, tachycardiac, and hypoxemic. Inspiratory stridor is noted by one of the staff members. Which agent should be administered acutely to prevent additional compromise? A. Epinephrine administered intravenously B. Epinephrine administered subcutaneously C. Norepinephrine D. Dopamine 7.13 A 71-year-old male is admitted to the cardiac in tensive care unit (ICU) for management of cardio genic shock and hypoxic respiratory failure. The patient is receiving fentanyl and dexmedetomi dine for analgesia and sedation while mechani cally ventilated, and dobutamine, epinephrine, and vasopressin are infusing to augment cardiac output (CO) and mean arterial pressure. Vital signs include BP 92/66 mm Hg and HR 98 bpm. The Sa o 2 is 96% on a fraction of inspired oxygen ( F io 2 ) 40%, and an arterial blood gas reveals a pH 7.21, Pa o 2 82 mm Hg, Pa co 2 39 mm Hg, and HCO 3 19 mEq/L. Serum lactate increased from 2.3 to 4.9 mmol/L over the past 24 hours. Which medication may be contributing to elevated se rum lactate? A. Dexmedetomidine 7.14 A 36-year-old male is admitted to the cardiac ICU after experiencing TdP secondary to an in tentional overdose of citalopram. IV magnesium supplementation was initiated by the primary team; however, TdP recurred thrice in the past 6 hours, with each recurrence successfully termi nated with defibrillations. An ECG recorded after the most recent episode records an HR 62 bpm and QTc 620 ms. Which strategy is best to prevent TdP recurrence? B. Dobutamine C. Epinephrine D. Vasopressin

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