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Refractory Acute Myocardial Infarction Cardiogenic Shock Due to Left Ventricular Outflow Tract Obstruction

Oludamilola Akinmolayemi1, Frans J Beerkens1, Vivian Hu2

  • 1Mount Sinai Fuster Heart Hospital, New York, New York, USA.

JACC. Case Reports
|August 15, 2025
PubMed

Insights

Cardiogenic shock (CS) after heart attack can be worsened by standard treatments. Recognizing left ventricular outflow tract obstruction (LVOTO) with echocardiography is key for effective CS management.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Echocardiography

Background:

  • Optimal management of cardiogenic shock (CS) following acute myocardial infarction (AMI) typically involves inotropes and mechanical circulatory support.
  • However, this standard approach may be detrimental in specific CS phenotypes, necessitating a re-evaluation of treatment strategies.

Observation:

  • A case of a 75-year-old female with anterior descending artery AMI presented with worsening CS despite intra-aortic balloon pump and inotrope therapy.
  • Echocardiography revealed unrecognized left ventricular outflow tract obstruction (LVOTO) caused by an apical aneurysmal infarct and hyperdynamic basal segments.

Findings:

  • Prompt echocardiography-guided adjustment of mechanical circulatory support and inotropes led to hemodynamic improvement.
  • This suggests dynamic LVOTO is an underrecognized complication of anterior-wall AMI-CS.

Implications:

  • Clinical vigilance and echocardiography are crucial for identifying patients with AMI-CS predisposed to LVOTO.
  • Recognizing and managing dynamic LVOTO can prevent counterintuitive hemodynamic deterioration caused by standard therapies.
Abstract

Keywords:
cardiogenic shockechocardiographyleft ventricular outflow tract obstructionmechanical circulatory supportmyocardial infarction

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