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Case Study Information:

A 53 y/o African American male with a history of CAD s/p remote PCI to unknown vessel(s), ischemic cardiomyopathy, HTN, DM, and CKD III has been hospitalized with decompensated heart failure. He is a retired salesman by profession. He has a 40 pack year history of smoking; he quit after his MI 6 years ago.

His medications include: Glyburide 10 mg, isosorbide mononitrate 80 mg daily, spironolactone 100 mg daily, digoxin 0.25 mg daily, furosemide 120 mg daily, enalapril 20 mg daily, and ASA 81 mg daily.

Echocardiography demonstrated regional wall motion abnormalities, moderate mitral regurgitation, and an ejection fraction of 25-35%, down from his previous EF of 40-50% on imaging obtained ~6 months ago. The patient was referred for cardiac catheterization.

Repeat coronary angiography appreciated multivessel coronary artery disease not amenable to PCI. An intra-aortic balloon pump was placed and CT surgery was consulted for CABG evaluation.

On transfer from the cath lab table to the stretcher, the patient converted to ventricular fibrillation and experienced cardiopulmonary arrest. ROSC was achieved after 3 minutes of ACLS and the patient was transferred to the CCU intubated and on vasopressor support. As the CCU AGACNP, you physically examine the patient and note that he is pallid, cold to the touch, with diffuse rhonchi on auscultation, and 3 pitting edema to his bilateral lower extremities.

Answer the questions below in 3 pages or less (excluding title page and references), in APA format.

1. Summarize the pathophysiology that is occurring in this patient.

2. Discuss anticipated invasive/non-invasive monitoring strategies for this patient and his expected hemodynamic parameters.

3. Summarize the management of the patient in the above scenario. Discuss the management decision based on evidence from the literature and utilization of current practice guidelines. At least one peer-reviewed, scholarly publication should be discussed, providing statistics from a research study or systematic review/meta-analysis. 

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