6768b0e0 17db 492a 9ac8 8b15c7f18f98
EKG fun!
63yo F sent from clinic for CHF exac. Reported to be in a "NSR". Just chilling in her chair, 3+ edema, BP 240/50, room air. Has a pacer and DM2. She won a ride to ICU...
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\n\n### Early 50s female with sudden onset CP. No significant cardiac hx. SCAD down LM to mLAD. 5x DES w/ good result. Worsening CV shock over the coming days. LVEF 16%. Inotropes and pressors started and eventually weaned completely over a few days. Diuresed and improved to 25% EF. Eventually D/C home, and return to hospital about a week later for s/s of heart failure. Florid pulm edema, bilateral PEs, BiV failure (L>R), hypoTN. Back on pressors, inotropes, diuresis, heparin. Good response to prior mentioned, but nil LVEF recovery (down to low 10s). Listed for transplant. Still worsening with medical optimization. CSx consulted. Urgent Impella 5.0 inserted, as EF 5<10% and increasing inopressor and O2 requirements. R Axilla approach. Uncomplicated. Exubated. Weaned off inopressors completely in 2d. Good biochemicals throughout. Weaned off O2. Mobilizing with much less SOB. Plan for transplant w/ or w/o durable VAD as bridge.