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ASTRAL/CORAL Renal Artery Stenting — EECC MCQ

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HardHypertension & Preventive CardiologyASTRAL/CORAL Renal Artery StentingEECC

A patient with acute myocardial infarction has cardiac index 1.6 L/min/m², pulmonary-capillary wedge pressure 24 mmHg, mean arterial pressure 54 mmHg and cool mottled peripheries despite cautious fluid assessment. Which vasoactive strategy is preferred while revascularisation and mechanical-support options are assessed?

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Correct answer: E — Restore pressure with norepinephrine, adding dobutamine if low output persists

In cardiogenic shock with severe hypotension, norepinephrine is preferred to dopamine for restoring perfusion pressure and has a lower arrhythmic burden. An inotrope such as dobutamine is added when cardiac output remains inadequate after pressure is supported. Pure inotropy can worsen hypotension, phenylephrine increases afterload, and levosimendan loading is not the first stabilising step in infarct-related shock.

Reference: 2021 ESC Guidelines for acute and chronic heart failure. https://academic.oup.com/eurheartj/article/42/36/3599/6358045