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Clinical case - Assist Devices in Cardiogenic Shock


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Dr Miklos Rohla, MD, PhD

& Prof. Alexander Geppert, MD & Prof. Kurt Huber, MD, FESC, FACC, FAHA

3rd Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna

The patient

Male, 53 years

Chest pain starting from 06:00, but patients goes to work

First medical contact 10:00

History:

  • Ulcerative colitis
  • Hep-C under treatment (PCR neg.)
  • Arterial hypertension
  • Smoking

First ECG

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Second ECG

Second ECG.jpg

ECG during emergency helicopter transport

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Acute angiography

PCI of RDG, followed by no-flow in the LAD

CPR, dislocation of guide wires, IMPELLA

Complex Intervention

Result after complex PCI prox LAD/RDG with 3DES

During Intervention:

  • Intubation
  • Abciximab
  • Epinephrin 8mg
  • Amiodarone 900mg
  • Atropin 1mg
  • pH < 7
  • Max CK 8800 U/l

Echo post Intervention

Echo 6 weeks post index event

  • Patient discharged after uneventful 2 weeks
  • Patient refused PCI of intermediate branch
  • Follow-up 6 weeks later 
  • Elective admission for PCI

Elective PCI intermediate branch

Vessel perforation – good result after stenting

Only mildly reduced LVF 10 weeks after the index event

Take home messages:

  1. Multi-vessel PCI in patients with acute myocardial infarction complicated by cardiogenic shock is currently not recommended.
  2.  Good short-term and mid-term clinical result - the benefits of Impella for certain patients might be underestimated by meta-analysis
  3. Further investigations are needed to establish the optimal strategy for treatment of bifurcation lesions in cardiogenic shock

 

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