Cardiology

Answer 4 Early surgical closure. Early surgical closure is critical for optimal management of post-MI ventricular septal rupture, even if the patient is clinically stable.4 IV nitroprusside and IABP are critical components of managing this patient. IABP counterpulsation decreases shunt fraction, improves coronary perfusion, improves blood pressure, and decreases systemic vascular resistance; it is commonly used as a bridge to surgery. IV nitroprusside also leads to decrease systemic vascular resistance; however, a greater decrease in pulmonary vascular resistance may occur, which would actually worsen shunting. In general, inotropic agents should not be used because they increase shunt fraction. REFERENCES 4. Fox AC, Glassman E, Isom OW. Surgically remediable complication of myocardial infarction. Prog Cardiovasc Dis 1979;107:852-5. Click here to return to the questions

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