Persistent Shock After Successful PCI Due to CPR-Related Internal Mammary Artery Hemorrhage

Shock is a common complication of acute myocardial infarction and cardiac arrest. Internal mammary artery (IMA) injury is a rare cause of post-cardiopulmonary resuscitation (CPR) hemorrhagic shock.

An 80-year-old woman presenting with inferior ST-segment elevation myocardial infarction underwent percutaneous coronary intervention to the left circumflex artery with intra-aortic balloon pump support after cardiac arrest treated with mechanical CPR. Persistent hypotension prompted computed tomography angiography, revealing a mediastinal hematoma with active right IMA extravasation. Urgent embolization resulted in hemodynamic stabilization and clinical recovery.

This case illustrates the diagnostic challenge of persistent shock after coronary revascularization when hemodynamic instability is disproportionate to the cardiogenic component and highlights CPR-related IMA injury as a rare but life-threatening extracardiac cause.

Persistent hypotension after ST-segment elevation myocardial infarction revascularization should prompt evaluation for extracardiac causes of shock, including CPR-related IMA injury, a rare complication that is amenable to prompt embolization.