A patient is seen in the emergency department for a myocardial infarction and cardiogenic shock. The physician assesses the patient for contraindications to an intra-aortic balloon pump (IABP). Which of the following is an absolute contraindication?


• The IABP works by inflating a balloon inside the descending aorta during diastole to displace blood and increase perfusion to the organs. During systole, the balloon rapidly deflates, reducing aortic volume through a vacuum effect and lessening the workload of the heart

• Absolute contraindications to an IABP include significant aortic regurgitation, since the degree of aortic regurgitation would be increased by the counterpulsation, pushing blood back into the left ventricle through the aortic valve each time the balloon inflates

• The other absolute contraindication is aortic dissection, since the balloon could dissect the aorta completely if it inflated inside the aorta

• Incorrect: AAA and peripheral arterial disease are relative contraindications, and an IABP can be used with caution. Vascular complications are the major risk associated with its use

• Incorrect: A hypertensive crisis is not a contraindication to an IABP

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