Rasul
Forum Guru
Topics: 56
Posts: 485
|
60 yo man admitted with MI in right coronary artery region. Hx of diabetes and HTN. No prior medications. ECG shows ST segm elevation in inferior leads. He's given thrombolytic, started on Nitro drip, metoprolol, anticoagulants. 2 hours later BP 85/60mmHg, HR 35 bpm. Next appropriate management:
a. Atropin inj
b. IV Dobutamine
c. IV fluids
d. Temporary pacemaker
e. Stop metoprolol
|
| amygdalaa
Forum Guru
Topics: 24
Posts: 399
|
d?
___________________
"If at any point you feel you cant..... then you MUST"
|
| achilles
Forum Guru
Topics: 88
Posts: 1,220
|
not sure but i''ll go for E-stop metoprolol.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| srf
Forum Guru
Topics: 73
Posts: 405
|
c is the answer. right sided failure. peripheral vasodilation by nitro drip decreases venous return.fluid is the answer.
___________________
life is reality without an eraser
|
| PKG
Forum Senior
Topics: 25
Posts: 62
|
hey guys....i think, the patient has complete heart block as a complication of the inferior wall MI...so the treatment should be atropine. besides, right sided heart failure will cause venous congestion and back pressure effects like JVD.It will not cause bradycardia of 35.by giving more iv fluids, you will only aggravate the failure.
any more opinions? i would really appreciate if rasul would post the answer with the explanation.
|
| Rasul
Forum Guru
Topics: 56
Posts: 485
|
Beautiful!!!
PKG, You're right. The answer is A. I went for the right heart failure too. They have a distractor-phrase in the question-MI in right coronary region. But what they discribe is inferior MI (EKG, Tx).
Now, right MI can cause brady too (because every hypovolemia can create paradoxal bradycardia, as a matter of fact hypovolemia goes as the first cause to exclude in bradycardia in ICU settings)-except it's more likely to be sinus bradycardia. If I'm not mistaken, a/v node's blood supply comes from right coronary artery, that's why they mentioned it in the question. The answer is : atropine, if no effect-temporary pacemaker.
|
| achilles
Forum Guru
Topics: 88
Posts: 1,220
|
rasul this was a good question. pls keep posting more.
amygdalaa, congrats on getting an externship. this should be really good for you. good luck to you.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
|
| |
| | | | | | | |
