CHEST Guidelines-Shock-After-Myocardial-Infarction

Shock-After-Myocardial-Infarction_chest

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The article discusses a case study of a 77-year-old woman who presented with progressive chest pain and was diagnosed with a myocardial infarction due to a 100% occlusion of the distal right coronary artery. Despite initial stabilization and treatment with a drug-eluting stent, she later developed worsening oxygenation and hypotension. A pansystolic murmur was noted, and bedside cardiac ultrasonography revealed a suspected ventricular septal defect (VSD) due to akinesis of the inferior septum and right ventricular enlargement.<br /><br />The investigation highlighted a crucial diagnostic step: Doppler color flow imaging, which confirmed a left-to-right shunt through the ventricular septum, indicative of a VSD. This is significant in differentiating between VSD and acute mitral regurgitation, both potential mechanical complications post-myocardial infarction. While a detailed transthoracic echocardiogram (TTE) is standard to diagnose these conditions, focused bedside ultrasonography proved invaluable, enabling rapid diagnosis and treatment decision-making.<br /><br />The case emphasizes the effectiveness of bedside ultrasonography in emergency settings to identify life-threatening complications like VSD. The use of color flow imaging is essential as two-dimensional imaging alone may not reveal the septal defect in most cases. Prompt diagnosis allowed for the patient’s transfer to a specialty cardiac center for urgent surgical intervention, where she received extracorporeal life support followed by VSD repair, resulting in an excellent recovery.<br /><br />Key takeaways underscore the importance of using focused cardiac ultrasonography in ICU settings for patients with shock, particularly when mechanical complications such as VSD or acute mitral regurgitation are suspected. This case demonstrates the immediacy and utility of ultrasound diagnostics in guiding emergent care for myocardial infarction complications.

Keywords

myocardial infarction

ventricular septal defect

bedside ultrasonography

Doppler color flow imaging

right coronary artery occlusion

cardiac ultrasound

mechanical complications

emergency diagnostics

extracorporeal life support

cardiac intervention