Cardiogenic Shock due to Pulseless Electrical Activity Arrest Associated with Severe Coronary Artery Spasm

Area of Science:

• Cardiology
• Interventional Cardiology
• Critical Care Medicine

Background:

• Coronary angiography is a standard procedure for diagnosing coronary artery disease.
• Catastrophic cardiogenic shock can occur during invasive cardiac procedures.
• Pulseless electrical activity (PEA) arrest is a critical emergency requiring immediate resuscitation.

Observation:

• A 75-year-old male patient developed ST-segment elevation myocardial infarction and cardiogenic shock immediately upon initiating coronary angiography.
• Left coronary arteriogram revealed critical obstructions: total occlusion of the left anterior descending artery and subtotal occlusion of the left circumflex artery.
• The patient presented with pulseless electrical activity arrest, necessitating cardiopulmonary support and prolonged cardiac massage.

Findings:

• Successful resuscitation was achieved after over 15 minutes of cardiac massage, with blood pressure returning to baseline.
• Notably, neither ventricular fibrillation nor ventricular tachycardia was observed during the event, distinguishing it from typical shock rhythms.
• The findings underscore a rare presentation of cardiogenic shock and PEA arrest secondary to acute coronary artery occlusion during angiography.

Implications:

• This case highlights the critical need for preparedness and rapid response protocols in interventional cardiology settings.
• Understanding the hemodynamics of PEA arrest in the context of acute coronary syndromes is crucial for effective management.
• Further research may elucidate specific risk factors or mechanisms leading to PEA arrest during angiography in patients with severe coronary artery disease.