Question

A 48-year-old male patient with a history of inferior myocardial infarction (MI) is admitted with an acute anterolateral MI. He is tachycardic and hypotensive. Cardiac index is 1.9 L/min/m2. Pulmonary artery occlusive pressure (PAOP) is 20 mm Hg, and systemic vascular resistance (SVR) is 2000 dynes/sec/cm-5. Which of the following is the priority in this patient?

A. Prevent dysrhythmias.
B. Increase myocardial perfusion.
C. Decrease preload.
D. Decrease afterload.

Answer 1

Option (D), The priority in managing a patient with acute MI, tachycardia, and hypotension is to decrease afterload, which will reduce the resistance the heart works against, improving cardiac output and myocardial perfusion.

Step-by-step explanation:

The priority in a 48-year-old male patient with a history of inferior myocardial infarction who is now experiencing an acute anterolateral MI, tachycardia, hypotension, with a cardiac index of 1.9 L/min/m2, a pulmonary artery occlusive pressure (PAOP) of 20 mm Hg, and systemic vascular resistance (SVR) of 2000 dynes/sec/cm-5 should be to decrease afterload.

This is because reducing afterload lessens the resistance against which the heart has to pump, thereby improving cardiac output and myocardial perfusion without increasing the oxygen demand on the already compromised myocardium. Medications that can be used to decrease afterload include vasodilators like sodium nitroprusside. However, care must be taken not to compromise perfusion to vital organs.