رجل عمره ٧٠ سنة في الصدمة القلبية، على مضخة البالون داخل الأبهر (IABP) عبر الشريان الفخذي الأيسر منذ يوم. كان نبض ذراعه اليسرى جيداً، وفجأة صار ضعيفاً جداً، ويده اليسرى أبرد من اليمنى، والضغط مستقر. ما التفسير الأرجح؟

A 70-year-old man in cardiogenic shock has had an intra-aortic balloon pump via the left femoral artery for a day. His left radial pulse was good but is suddenly very weak and his left hand is cooler than the right; BP is stable. What is the most likely explanation?

1. The balloon is working well and unloading the left ventricle
2. Hypovolaemia needing a fluid bolus
3. Tachycardia caused by pain at the insertion site
4. The balloon has migrated up and occluded the left subclavian

Answer: D) The balloon has migrated up and occluded the left subclavian. The balloon tip should sit just below the left subclavian artery. A weak left arm pulse suggests upward migration, and falling urine output suggests downward migration over the renal arteries. Report immediately.