CARDIOGENIC SHOCK IN A FORTY YEAR OLD FEMALE: COULD VASCULAR GENETICS PLAY A ROLE?

Abstract

Cardiogenic shock remains a leading cause of death in Acute Myocardial Infarction (AMI). The incidence occurs in about 5 - 8% of patients hospitalized with STEMI and has a mortality rate of about 50%. This case study will explore a phenomena termed “inherent vascular disease” as a cause of cardiogenic shock in a forty year old female. This under recognized disease is poorly documented in the literature and leads the practitioner to question if it could be an independent risk factor for PCI/surgical outcome. This case study will review the results of a percutaneous coronary intervention (PCI) for a forty year old female presenting with a STEMI and the events that lead to a subsequent PCI and emergent surgical revascularization. Following Coronary Artery Bypass Grafting this patient continues in cardiogenic shock supported by intra-aortic balloon therapy and then on to further left ventricular support via Impella 5.0. Following two weeks of intensive medical therapy; including LVAD repositioning, daily hemodialysis and consideration for transplantation, a difficult decision is made. With her husband and two school-age children at the bedside our forty year old patient is removed from life support. This case study will provide an overview of the pharmacological and mechanical therapies available to support those with cardiogenic shock. We will explore the impact of inherent vascular genetics on the outcome of both interventional and surgical revascularization. In conclusion a review of the current literature on end of life care for acute cardiovascular insults will be discussed.