Successful Management of Acute Coronary Syndrome with Cardiogenic Shock, Severe Mitral Regurgitation and Multi-organ Dysfunction: A Case Report

Abstract

Acute coronary syndrome (ACS) with cardiogenic shock has worst prognosis. Early revascularization has been shown to be beneficial in cases who present early; but many a times, patients present late after ACS and their hemodynamics is compromised by systemic inflammatory response syndrome and multi-organ dysfunction. We hereby present a case of anterior wall myocardial infarction with severe left ventricular systolic dysfunction (left ventricular ejection fraction (LVEF):27%) and severe secondary mitral regurgitation (MR), who presented late after ACS and was in cardiogenic shock, pulmonary edema and had acute kidney injury on presentation. The patient was initially managed conservatively with dual oral antiplatelets, statins, glycoprotein IIb/IIIa inhibitors infusion (tirofiban), parentral anticoagulation, inotropes, diuretics, and mechanical ventilation. She was taken up for coronary angiography and percutaneous coronary intervention to left anterior descending artery and chronically occluded left circumflex artery during same admission after stabilization of hemodynamics. She tolerated the procedure well and her repeat echocardiogram (done after two weeks) showed LVEF of 50% and mild MR. This case highlights an alternative approach to manage ACS with cardiogenic shock, who presents late after acute event.