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ACCP-SEEK Board Review Question of the Month |

Worsening Hypotension in a 60-Year-Old Man Requiring Intra-aortic Balloon Counterpulsation*

Joseph Parrillo, MD, FCCP
Author and Funding Information

*From the ACCP-SEEK program, reprinted with permission. Items are selected by Department Editors Richard S. Irwin, MD, FCCP, and John G. Weg, MD, FCCP. For additional information about the ACCP-SEEK program, phone 1-847-498-1400.

Correspondence to: Joseph Parrillo, MD, FCCP, Rush-Presbyterian-St. Lukes Medical Center, 1653 W Congress Pkwy, Jelke 1026, Chicago, IL 60612-3833



Chest. 1999;116(3):801-802. doi:10.1378/chest.116.3.801
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A 60-year-old man with cardiogenic shock due to recent myocardial infarction requires intra-aortic balloon counterpulsation (IABP) in order to maintain adequate hemodynamics. During the past few minutes, the patient’s mean arterial BP has decreased from 70 to 45 mm Hg, and you suspect IABP malfunction. The action of the pump is timed from the patient’s arterial BP tracing, and the balloon inflates with every beat. To diagnose a potential problem, you change the timing of balloon inflation to every third beat. The arterial pressure waveform is shown in Figure 1. Which of the following is the most likely cause of the patient’s decrease in BP?

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