CCRN
Cardiovascular
Which set of hemodynamic goals is most appropriate for a patient with severe aortic stenosis?
- AMaintain preload and sinus rhythm, and avoid hypotension and tachycardia
- BReduce preload with diuretics and nitrates to ease the work of the heart
- CLower systemic vascular resistance with vasodilators to unload the ventricle
- DKeep the heart rate above 100/min to raise the cardiac output
Not B. Diuretics and nitrates reduce the preload that a stiff, hypertrophied ventricle needs and can cause profound hypotension.
A is right. With a fixed outflow obstruction, stroke volume depends on adequate filling, a well-timed atrial contraction, and enough diastolic time and pressure to perfuse the thickened myocardium. Hypotension, tachycardia, loss of sinus rhythm or a sudden fall in preload can start a downward spiral of ischemia and falling output.
