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Insulin for a Broken Heart
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A3476 - Insulin for a Broken Heart
Author Block: A. Iardino1, O. Garner2, F. Lotta3; 1Internal Medicine, Texas Tech Healh Science Center, Odessa, TX, United States, 2Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, United States, 3Critical Care Medicine, Centro Policlinico Valencia ""La Viña"", Valencia, Venezuela, Bolivarian Republic of.
The no reflow phenomenon [NRP] is a microvascular obstruction that reduces flow to the myocardium after a coronary percutaneous intervention [CPI] and is usually managed with intracoronary infusion of vasodilator drugs such as Adenosine, Verapamil, Nitroglycerine, or Nitroprusside. We present a 65 year-old Hispanic male with no significant past medical history who presented to the emergency department with acute coronary syndrome (ACS) presenting as ST elevation myocardial infarction and complete AV Block due to a complete occlusion of right coronary artery (RCA) that after placement of drug eluting stent (DES) went into ventricular fibrillation which converted into normal sinus rhythm with early desynchronized cardioversion; patient became immediately hypotensive with a mean arterial pressure (MAP) of 46 mmHg. Intracoronary infusion of verapamil was given unsuccessfully and patient hypotension worsened for which triple vasoactive drug therapy was started with no improvement. MAP went down to 36 mmHg in maximum doses of vasoactive drugs; high dose insulin drip was started and 30 min later MAP went up to 67 mmHg with complete discontinuation of vasoactive drugs. Patient was discharge to medical floor four days after admission and home seven days later. Therapy with high regular insulin has shown to be effective in septic shock when patients are unresponsive to inotropic therapy. The anti-inflammatory effect of insulin suppressing tumor necrosis factor-α, interleukin-1, and intracellular adhesion molecules are thought to be the factors that aid in refractory shock. Studies with large populations are warranted to establish if insulin can be used routinely in patients that do not respond to vasoactive drugs, but it has been used successfully in the past and can be considered if conventional therapy fails.
Author Block: A. Iardino1, O. Garner2, F. Lotta3; 1Internal Medicine, Texas Tech Healh Science Center, Odessa, TX, United States, 2Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, United States, 3Critical Care Medicine, Centro Policlinico Valencia ""La Viña"", Valencia, Venezuela, Bolivarian Republic of.
The no reflow phenomenon [NRP] is a microvascular obstruction that reduces flow to the myocardium after a coronary percutaneous intervention [CPI] and is usually managed with intracoronary infusion of vasodilator drugs such as Adenosine, Verapamil, Nitroglycerine, or Nitroprusside. We present a 65 year-old Hispanic male with no significant past medical history who presented to the emergency department with acute coronary syndrome (ACS) presenting as ST elevation myocardial infarction and complete AV Block due to a complete occlusion of right coronary artery (RCA) that after placement of drug eluting stent (DES) went into ventricular fibrillation which converted into normal sinus rhythm with early desynchronized cardioversion; patient became immediately hypotensive with a mean arterial pressure (MAP) of 46 mmHg. Intracoronary infusion of verapamil was given unsuccessfully and patient hypotension worsened for which triple vasoactive drug therapy was started with no improvement. MAP went down to 36 mmHg in maximum doses of vasoactive drugs; high dose insulin drip was started and 30 min later MAP went up to 67 mmHg with complete discontinuation of vasoactive drugs. Patient was discharge to medical floor four days after admission and home seven days later. Therapy with high regular insulin has shown to be effective in septic shock when patients are unresponsive to inotropic therapy. The anti-inflammatory effect of insulin suppressing tumor necrosis factor-α, interleukin-1, and intracellular adhesion molecules are thought to be the factors that aid in refractory shock. Studies with large populations are warranted to establish if insulin can be used routinely in patients that do not respond to vasoactive drugs, but it has been used successfully in the past and can be considered if conventional therapy fails.
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