SCAI/EAPCI/ACVC Expert Consensus Statement on Cardiogenic Shock in Women-Dr. Naidu slides

Dr. Naidu slides

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This case report highlights the management challenges of cardiogenic shock (CS) in a 59-year-old woman with significant cardiovascular and pulmonary comorbidities. The patient, with a history of coronary artery disease (CAD) and recent COVID-19 pneumonia, presented with shortness of breath, hypoxia, and signs consistent with pneumonia and emphysema. Initial workup was complicated by atypical symptoms and relatively unremarkable labs aside from elevated lactate and troponin, delaying the diagnosis of CS.<br /><br />Echocardiogram revealed newly reduced left ventricular ejection fraction (25%) with moderate to severe valvular dysfunction, supporting a diagnosis of non-ST elevation myocardial infarction complicated by acute hypoxic respiratory failure and possible cardiogenic shock. Right heart catheterization confirmed elevated filling pressures and low cardiac index. Due to severe peripheral arterial disease (PAD), mechanical circulatory support (MCS) options such as intra-aortic balloon pump (IABP) and Impella were contraindicated. The patient was treated with dobutamine and diuresis, achieving lactate clearance and extubation.<br /><br />Despite medical optimization and plans for high-risk percutaneous coronary intervention (PCI) after respiratory improvement, the patient experienced clinical deterioration, complicated by anxiety and pulmonary edema. Although multidisciplinary discussions led to a plan for elective intubation and axillary IABP insertion prior to PCI, she suffered a pulseless electrical activity (PEA) arrest followed by ventricular fibrillation and died despite resuscitation efforts.<br /><br />Key learning points echo recommendations from the SCAI/EAPCI/ACVC consensus on cardiogenic shock in women: early diagnosis through frequent end-organ assessments and invasive hemodynamics is critical and achievable; however, delays in MCS initiation due to comorbidities and therapeutic hesitations remain an issue. Women with CS often experience less aggressive intervention and longer delays to definitive revascularization than men, negatively impacting outcomes. This case underscores the importance of timely, aggressive management and tailored treatment strategies to improve survival in women with cardiogenic shock.

Keywords

cardiogenic shock

coronary artery disease

COVID-19 pneumonia

left ventricular ejection fraction

valvular dysfunction

mechanical circulatory support

intra-aortic balloon pump

percutaneous coronary intervention

pulseless electrical activity arrest

sex differences in cardiogenic shock