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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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High-risk percutaneous coronary intervention in a patient with a single coronary artery presenting as STEMI and

Murad Abdelsalam1, Mrinalini Krishnan2, Sandeep Banga3

  • 1Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA.

BMJ Case Reports
|August 16, 2015
PubMed

Insights

This case study details a rare instance of cardiogenic shock from ST elevation myocardial infarction in a patient with a single coronary artery. Successful stenting of the occluded right coronary artery restored blood flow, demonstrating a viable treatment approach.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • ST-elevation myocardial infarction (STEMI) leading to cardiogenic shock is a critical cardiovascular emergency.
  • A single coronary artery anomaly presents unique challenges for diagnosis and treatment.
  • Anomalous coronary artery origins require careful anatomical assessment before intervention.

Observation:

  • An 81-year-old woman presented with chest pain and near syncope, indicative of acute myocardial infarction.
  • Coronary angiography revealed a single, proximally occluded right coronary artery and an anomalous left main coronary artery originating from it.
  • The distal left circumflex artery was also occluded, with retrograde flow dependent on collaterals from the right coronary artery.

Findings:

  • Successful percutaneous coronary intervention (PCI) with stenting of the occluded right coronary artery was performed without compromising the anomalous left main coronary artery origin.
  • Restoration of antegrade flow in the right coronary artery re-established perfusion to the territory supplied by the anomalous left main coronary artery.
  • Flow in the chronically occluded left circumflex artery was re-established through collateral circulation.

Implications:

  • This case highlights the importance of recognizing complex coronary artery anomalies in patients with acute myocardial infarction.
  • A systematic and cautious approach to coronary angiography and intervention is crucial for procedural success in such rare anatomies.
  • Successful management of cardiogenic shock in single coronary artery anomalies can be achieved with meticulous planning and execution.

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