Summary Update

Our patient has now been in the emergency department for twenty minutes and the catheterization laboratory was alerted ten minutes after arrival. At this time, the laboratory called to notify the emergency department that they would be ready for the patient in about fifteen minutes. Because of her acute congestive failure, reflected by her examination and chest X ray, she had been given an intravenous rapidly acting diuretic. Because she had developed a right bundle branch block, an external pacemaker was made available. She was still diaphoretic, her blood pressure was now 110/80 mmHg, pulse 90, respirations 20. Her physical examination was otherwise unchanged.

The attending cardiologist was concerned about her clinical status and elected to carry out an emergency echo-Doppler study. There was still time before the catheterization laboratory would be ready and echocardiography would evaluate the degree of compromise of her cardiac function including wall motion and ejection fraction. It would also define possible mechanical complications, such as mitral regurgitation from papillary muscle dysfunction, ventricular septal defect and pericardial effusion, although her bedside findings did not suggest these problems.