A 65-year-old man on ICU has severe aortic stenosis (AVA 0.6 cm², mean gradient 55 mmHg). He develops flash pulmonary oedema. The team initiates IV GT...

Question

A 65-year-old man on ICU has severe aortic stenosis (AVA 0.6 cm², mean gradient 55 mmHg). He develops flash pulmonary oedema. The team initiates IV GTN for preload reduction. Shortly after, his BP drops from 95/60 to 55/30 mmHg and he becomes peri-arrest. What happened?

Accepted Answer

GTN-induced preload reduction caused cardiovascular collapse - in severe AS, cardiac output is critically dependent on adequate preload because the fixed valve obstruction limits the ability to increase stroke volume; preload reduction removes this compensatory mechanism, causing catastrophic hypotension

Answer

GTN is always safe in aortic stenosis

Answer

The GTN was contaminated

Answer

He has developed a PE

Answer

The BP cuff is inaccurate

uk-fficm MCQ (SBA): Aortic Stenosis - Vasodilator Collapse

A 65-year-old man on ICU has severe aortic stenosis (AVA 0.6 cm², mean gradient 55 mmHg). He develops flash pulmonary oedema. The team initiates IV GTN for preload reduction. Shortly after, his BP drops from 95/60 to 55/30 mmHg and he becomes peri-arrest. What happened?