Four days after a transmural MI, a 74-year-old man develops hypotension and congestive heart failure. The following is/are true:
belongs to book: ASIR SURGICAL MCQs BANK|Dr. Gharama Al-Shehri|1st edition| Chapter number:12| Question number:140
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a. An intra-aortic balloon pump should be used and cardiac catheterization performed
c. Pulmonary wedge pressure tracing of prominent V waves without an O2 step-up suggests papillary muscle rupture
Both ventricular septal defect (VSD) and ruptured papillary muscle occur from 3–5 days post-MI and should be managed by intra-aortic balloon pump, decreasing afterload and cardiac catheterization for diagnosis. A VSD is most likely in an elderly hypertensive female who has sustained an anterior transmural MI; posterior MIs typically lead to papillary muscle rupture which is diagnosed by prominent V waves on pulmonary wedge pressure tracing. Survival rate for both of these complications is improved by early rather than late repair.
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