Figure 3.

Simulation of haemodynamics in a NSTEMI case with all myocardium being perfused via two subtotal stenoses to demonstrate circulatory effects of ischaemia (left column), support by intra‐aortic balloon pump (IABP, middle column), or LV unloading using an Impella microaxial pump (right column). The simulation demonstrates the loss of contractility and cardiac output of an impaired left ventricle during balloon insertion in one of the subtotal stenoses without support (bottom left), on IABP (bottom middle), or on Impella CP (bottom right). The curved arrows in the upper panels indicate the initial improvement in contractility upon activation of either IABP or Impella before balloon insertion compared with ischaemia; the straight arrows indicate the decline of contractility following balloon‐mediated occlusion of one of the subtotal stenoses. The second panel from the top illustrates the consequence on aortic pressure over time. Aortic and left ventricular pressure are shown before (third panel from top) and after (bottom panel) coronary occlusion by balloon angioplasty. Clinical details are given in the main text. AoP, aortic pressure; IABP, intra‐aortic balloon pump; LVP, left ventricular pressure; LVV, left ventricular volume; PV loop, pressure–volume loop.