Cardiogenic Shock in COVID-19 and Hostile Vascular Access
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:
Cardiogenic Shock in COVID-19 and Hostile Vascular Access
Introduction:
Cardiogenic shock is infrequently seen in a non-ST-segment-elevation myocardial infarction (NSTEMI) in patients with COVID-19 infection. In this case, we seek to highlight the management of a left main coronary artery (LMCA) as a culprit for NSTEMI with cardiogenic shock in COVID-19.
Clinical Case:
A 68-year-old woman presented with a recurrent COVID-19 infection and was intubated in the emergency department. Her initial troponin was increased at 1.66 ng/mL and increased to 6.1 ng/mL, however given her normal and unchanged ECG she was managed medically. On day 3 of her hospitalization, she developed anterolateral ECG changes suggestive of LMCA involvement. Her coronary angiography demonstrated critical proximal LMCA stenosis and a chronic total occlusion of the right coronary artery. Left ventricular end-diastolic pressure was measured at 34 mm Hg and peripheral angiography demonstrated poor vascular access. Due to the inability to provide mechanical circulatory support, a decision was made to provisionally stent the left anterior descending artery into the LMCA. Post-procedurally, the patient's cardiogenic shock resolved and she was weaned off her vasoactive medications. She continued to have worsening respiratory status, and developed septic shock and mesenteric ischemia resulting in her death in the intensive care unit.
Discussion:
This case highlights the emergent management of cardiogenic shock in a patient with COVID-19 and LMCA stenosis.