Cardiovascular Critical Care I

(i.e., supraventricular tachycardia) to terminate the

arrhythmia or to help differentiate atrial from ventricu-

lar arrhythmias.

Answer: C

The physician is considering heparin anticoagulation

while the patient is in the ICU. Although valuable to

consider for long-term anticoagulation, the HAS-BLED

score is not validated for bleeding risk specific to hepa-

rin anticoagulation. Nonetheless, given the patient’s

CHA2DS2-VASc score (annual stroke risk of 6.7%),

anticoagulation should be considered, making Answer

C correct and Answer D (“anticoagulation is not war-

ranted”) incorrect. Answer A, “the patient’s risk of

bleeding is the same as his stroke risk,” and Answer B,

“the patient’s risk of stroke exceeds his risk of bleed-

ing,” are incorrect statements because the foundation of

these scores does not include risk of thromboembolism

during ICU stay, nor do the scores assess risk of bleed-

ing on heparin infusions.

Answer: C

Given his ongoing cardiogenic shock, this patient is

unlikely to remain stable without intervention; thus,

Answer D is incorrect. To help stabilize him, intra-

aortic balloon counterpulsation (Answer C) would best

facilitate selective afterload reduction during systole

(increasing cardiac output in a patient with a low ejection

fraction and severe mitral regurgitation) while provid-

ing augmented diastolic pressures. Venovenous ECMO

(Answer B) is unlikely to help because this means of

MCS depends on a functional LV and RV to provide for-

ward blood flow. Venoarterial ECMO (Answer A) may

stabilize the patient; however, it would increase after-

load on the aortic valve, which could worsen his mitral

regurgitation. Furthermore, this degree of MCS may be

unwarranted at this time unless the patient develops pro-

gressive hypoxic cardiopulmonary failure.