IABP, When should it not be used? - USMLE Forums
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  #1  
Old 03-04-2013
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Heart IABP, When should it not be used?

A 72 year old man with history of Diabetes Mellitus is rushed to the emergency room by the EMS 30 minutes after he collapsed at his home with severe left sided chest pain. Upon arrival, the patient was found to have very low blood pressure at 70/40 mm Hg. Chest examination revealed diffuse coarse crepitations. An electrocardiogram showed ST elevations in the anterior leads with reciprocal depressions. The patient was immediately started on Aspirin, GP IIb/IIIA inhibitors, Clopidogrel and Heparin. He is placed on 50% 02 by Venturi mask and his oxygen saturation on this supplemental oxygen is 92%. A diagnosis of cardiogenic shock and pulmonary edema is made and the patient is admitted to intensive care unit. The patient is placed on Intra-Aortic Balloon Counterpulsation Pump (IABP) and is rushed to cardiac catheterization lab. In which of the following situations, IABP confers more harm than benefit?

A) Acute Mycocardial Infarction (MI) with Cardiogenic Shock
B) Aortic dissection with aortic regurgitation
C) Severe left ventricular failure with pulmonary edema
D) Post-MI Ventricular Septal Perforation
E) Post-MI Acute Mitral Regurgitation
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Old 03-05-2013
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Default B) Aortic dissection with aortic regurgitation

B) Aortic dissection with aortic regurgitation
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Old 03-05-2013
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B) Aortic dissection with aortic regurgitation

Quote:
The Intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing cardiac output. Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery. It consists of a cylindrical polyethylene balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery[1] and counterpulsates. That is, it actively deflates in systole, increasing forward blood flow by reducing afterload. It actively inflates in diastole, increasing blood flow to the coronary arteries. These actions combine to decrease myocardial oxygen demand and increase myocardial oxygen supply.
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