q~~~~~~~~~~2 - dep

[ArchivalUser]

Hi,

Since the etiology of the hypotension is likely due to SA node dysfunction, secondary to infarction in RCA territory. So, the goal of the treatment is to boost SA nodal activity.

Thus, I agree a trial of anti-cholinergic, and if not successful, pacing, would be reasonable. In addition, treating the MI itself with either PCI or thrombolytics is inherently important too.

drpanchet: Dobutamine is a beta1 agonist, is mainly used to increase contractility. Because hypotension was probably not due to an marked decrease in contractility, it should not be used b.c. it will adversely drive up the cardiac workload which is very undesirable for a ailing heart that is undersupplied with O2.
(ps. dobutamine, if it is doing anything to blood vessels, MIGHT dilate rather than constrict them since it is a beta-agonist; in fact, vessel constriction is not desirable in MI in general b.c. it will also incraese the cardiac work load).

[ArchivalUser]

I would like to add: though atropin will also increase cardiac workload but this would be a worthy sacrifice.

[ArchivalUser]

thanx juicy for correctin me

[ArchivalUser]

@ drpanchet........congrats yur team won today!....im still in denial regarding man u

[ArchivalUser]

@ waynerooney: thanx buddy! liverpool played good but we came out wid 3 points
sorry about manu loss; i expected them to close down the gap. you( waynerooney) were unlucky to hit the cross bar! i've always been anti-chelsea n so would luv to see title won by either arsenal or manu! cheers!
n hey! would u please email me at thisismosman@live.com n give me yor email ID

[ArchivalUser]

drpanchet,

you are very wellcome

[ArchivalUser]

Sorry for late reply

The correct answer is A. The patient is hypotensive and bradycardic. This suggests a vagal response, and administering an anticholinergic agent, such as atropine, is the correct treatment.

Inotropic agents, such as dobutamine (choice B), are not indicated at this time, since the patient is hypotensive. If other methods of resuscitation, such as IV hydration, fail, then a pressor is indicated.

A beta blocker, such as metoprolol (choice C), is indicated in the setting of a myocardial infarction, given its cardioprotective effect. In this acute setting, however, its effect on the pulse and blood pressure will be counter-productive.

If the bradyarrhythmia and hypotension persist after the administration of atropine, the insertion of a temporary pacemaker is indicated (choice D). If the patient develops a sick sinus syndrome as a result of the infarct, and is symptomatic in terms of hypotension and syncope, then a pacemaker may be needed.

Cardiac catheterization is indicated in the acute setting (choice E). In this patient, 8 hours have elapsed, and his ST segments have resolved. If he develops another ST segment elevation myocardial infarction, then he will need an emergent catheterization.

[ArchivalUser]

In CCU sudden dramatic changes in rhythm or rate are given immediate attention before BP