Treatment of cardiogenic shock in PCI center without the possibility of mechanical circulatory support: Case report and review of the contemporary data

Introduction: Cardiogenic shock (CS) is one of the most severe conditions met in the cardiac intensive care unit, with a short-term mortality rate of 30-40%. It represents a syndrome of hypoperfusion and organ dysfunction due to a primarily cardiac cause, most commonly as a consequence of acute myocardial infarction (AMI). Aim: To present a case of an advanced age female patient treated for CS following acute myocardial infarction in a PCI center without the availability of mechanical circulatory support. Case report: An 85-year-old female patient was admitted to the Invasive cardiology department of Health Center Zaječar, presenting with an anterior wall STEMI, 9 hours after the onset of chest pain in Forrester class III CS. Primary PCI of the LAD was performed, after which she was treated with inotropic support of norepinephrine in a maximal dose of 0.35 mcg/kg/min, along with cautious infusion of crystalloid fluids and other heart failure therapy. Upon the administered therapy, the patient hemodynamically stabilized and inotropic stimulation ceased despite ongoing severe left ventricular systolic dysfunction with an EF of 15-20% and severe mitral regurgitation. The further clinical course was complicated by aspiration pneumonia, diarrheal syndrome, and dehydration with hypernatremia, eventually resulting in a fatal outcome after 21 days of treatment. Conclusion: Emergency primary PCI procedure in the nearest PCI center, along with the administration of inotropic agents and other supportive measures in the cardiac intensive care unit, can lead to hemodynamic stabilization even in critically ill patients of advanced age with CS.