Читать книгу Interventional Cardiology - Группа авторов - Страница 347

A patient with CS complicating AMI should ideally be started on inotropes and vasopressors as soon as possible and be transferred to a catheterization laboratory for emergent invasive angiography. In order to better understand the etiology of CS immediate echocardiography should be performed ideally without delaying emergency angiography. A rapid bedside echo in the catheterization laboratory during preparation of the patient may suffice to evaluate left and right ventricular function and possible mechanical complications such as a ventricular septal rupture, papillary muscle rupture, or a free wall rupture. In the absence of mechanical complications, one should proceed to emergency PCI (preferably of the culprit‐lesion only) or emergency CABG if the lesions are not deemed amenable to PCI. In case of mechanical complications, surgical intervention is warranted. Short‐term percutaneous mechanical support may be considered before performing PCI as observational studies have suggested improved outcomes with early‐ rather than late initiation of mechanical support [40]. Before, throughout and after the procedure the respiratory status, blood pressure, and urine output should be monitored and mechanical ventilation, uptitration of vasopressors/inotropes, initiation or escalation of mechanical support, and renal replacement therapies should be considered. Moreover, the insertion of a pulmonary artery catheter may be considered.