Abstract
IntroductionCardiogenic shock is very uncommon in healthy people. The differential diagnosis for patients with acute heart failure in previously healthy hearts includes acute myocardial infarction and myocarditis. However, many drugs can also depress myocardial function. Propofol and fentanyl are frequently used during different medical procedures. The cardiovascular depressive effect of both drugs has been well established, but the development of cardiogenic shock is very rare when these agents are used.Case presentationAfter a minor surgical intervention, a 32-year-old Caucasian woman with no significant medical history went into sudden hemodynamic deterioration due to acute heart failure. An urgent echocardiogram showed severe biventricular dysfunction and an estimated left ventricular ejection fraction of 20%. Extracorporeal life support and mechanical ventilation were required. Five days later her ventricular function had fully recovered, which allowed the progressive withdrawal of medical treatment. Prior to her hospital discharge, cardiac MRI showed neither edema nor pathological deposits on the delayed contrast enhancement sequences. At her six-month follow-up examination, the patient was asymptomatic and did not require treatment.ConclusionAlthough there are many causes of cardiogenic shock, the presence of abrupt hemodynamic deterioration and the absence of a clear cause could be related to the use of propofol and fentanyl.
Highlights
Cardiogenic shock is very uncommon in healthy people
extracorporeal life support (ELS) is a variation of cardiopulmonary bypass which could improve the outcomes of patients in cardiogenic shock [1]
There is a rare possibility of convulsions, chest pain, arrhythmias, hypotension, or bradycardia associated with using ondansetron, but we have not found any case in the literature describing a connection between the use of this drug in the post-operative and the development of heart failure (HF)
Summary
Cardiogenic shock is the most serious form of presentation of heart failure (HF). The anticipation of hemodynamic deterioration and multiple organ failure in these patients is very important in terms of survival. Case presentation We report the case of a 32-year-old Caucasian woman who experienced sudden, severe hemodynamic deterioration after undergoing a minor surgical procedure Her medical history was unremarkable except for a vaginal delivery two years before. Pulse oximetry showed that her oxygen saturation level had decreased to 80% despite oxygen supplementation through a face mask (fraction of inspired oxygen 40%) In this clinical situation, we treated her with intravenous dopamine and dobutamine, as well as with mechanical ventilation because of global respiratory failure (arterial gasometry: oxygen pressure 40 mmHg, carbon dioxide pressure 49 mmHg). Three weeks later a new TTE showed a non-dilated left ventricle, an absence of segmental contractility alterations, and a LVEF in the normal range (Figure 1B and Additional files 3 and 4, movies 3 and 4). At her six-month follow-up examination, the patient was asymptomatic and did not require further treatment
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