Simultaneous occlusion of 2 coronary arteries--a rare cause of cardiogenic shock

Unstable coronary artery plaque rupture resulting in acute thrombosis is the most common reason of acute myocardial infarction. Atherosclerotic plaque rupture is thought to reflect local plaque instability attributable to spontaneous or triggered disruption of a vulnerable plaque that is manifested angiographically as a single lesion (culprit lesion). Plaque instability might be caused, however, by pathophysiologic processes, such as inflammation ("panarteritis"), that exert adverse effects throughout the coronary vasculature and therefore result in multiple unstable lesions and multivessel thromboses. We report a case of a 51-year-old man, heavy smoker, who presented with 3-hour history of severe chest pain and signs of cardiogenic shock. A 12-lead electrocardiogram showed third-degree atrioventricular block with junctional rhythm of 35 beats per minute and ST elevations in leads II, III, aVF, and V1 through V6. Temporary endocavital pacing was immediately introduced and initiated. In coronary angiography, simultaneous occlusions of left anterior descending and right coronary arteries were found. Primary angioplasty of both culprit vessels was successfully performed. Intra-aortic balloon pumping was inserted. After intervention, significant improvement in the patient's condition was observed. In 6-month follow-up, he was asymptomatic and in good general condition. Fast and effective primary coronary intervention seems to be crucial in salvaging the myocardium, to preserve left ventricular function and to improve prognosis.