Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions


Answer 4
  1. 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.

     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


Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj