Out-of-hospital cardiac arrest with anterior STEMI
Presenter
Saraschandra Vallabhajosyula, MD MSc, FSCAI, Warren Alpert Medical School of Brown University, Providence, RI
Saraschandra Vallabhajosyula, MD MSc, FSCAI, Warren Alpert Medical School of Brown University, Providence, RI and Tanveer Rab, M.D., FSCAI, Emory University, Brookhaven, GA
Title:
Out of Hospital Cardiac Arrest with Anterior STEMI
Introduction:
Cardiac arrest and cardiogenic shock frequently co-exist and contribute to worse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). In this case, we present a report of evolving shock in STEMI.
Clinical Case:
A 63-year-old female presented with chest discomfort, and developed cardiac arrest in the emergency department. She underwent resuscitation and post-arrest electrocardiogram demonstrated anterior STEMI. At this time, emergent coronary angiography demonstrated severe distal left main coronary artery disease (LMCA) with poor flow in the left anterior descending artery (LAD). Her left ventriculogram showed an ejection fraction of 10-15% with anterior and apical wall motion abnormalities. Her left ventricular end-diastolic pressure was 40 mmHg and therefore she underwent pecutaneous left ventricular assist device placement. She underwent intravascular ultrasound-guided percutaneous coronary intervention (PCI) of mLAD, pLAD, proximal left circumflex artery, and distal LMCA. She received a reverse double kissing crush PCI of her distal LMCA with Impella-support. Post-PCI, her hemodynamics demonstrated normal biventricular filling pressures. She developed an acute decrease in her hemoglobin with a visible right groin hematoma. She was transferred to the hub-shock center where she underwent her left ventricular assist device removal and manual compression. During the hospitalization, the patient received multiple blood products, and continued to be dependent on invasive mechanical ventilation. She developed superior vena caval syndrome and was diagnosed with non-small cell lung cancer. Due to lack of options for inpatient chemotherapy, she was transferred to inpatient hospice and was subsequently lost to follow-up.
Discussion:
Cardiac arrest is frequently complicated by cardiogenic shock in STEMI. Careful management of vascular and limb complications form the bedrock for safety in this population.