One day after his admission the patient appeared increasingly diaphoretic, with evidence of poor perfusion of his distal extremities and a decrease in cardiac output from 3.0 to 2.4 L/min. He was returned to the catheterization lab for placement of an intra-aortic balloon pump. Repeat angiography of the left coronary artery demonstrated that his stent was completely patent and he had an ejection fraction of 25%.

Hemodynamics following balloon pump placement:

RA 11 mm Hg, wedge 16 mm Hg, PA 31/20 with mean of 24 mm Hg, cardiac output 3.7 L/min, cardiac index 1.8.

Blood pressure by femoral arterial line was 109/64.