title: An unusual case of cardiogenic shock: common cause from uncommon etiology.
abstract: Mechanical complications of an acute coronary syndrome can lead to hemodynamic instability out of proportion to the degree of left ventricular dysfunction. We present the case of a patient with cardiogenic shock secondary to severe mitral regurgitation in the setting of an acutely occluded obtuse marginal artery. Echocardiography and pathologic findings revealed an uncommon cause of anterolateral papillary muscle rupture. Using the unique features of this case, we present a clinical self-assessment exercise highlighting the challenges involved in the management of this type of patient.
authors.affiliation: Divisions of Cardiology and Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Katie M
authors.initials: KM
authors.lastname: Giles
authors.affiliation: Divisions of Cardiology and Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Rajeev V
authors.initials: RV
authors.lastname: Rao
authors.affiliation: Divisions of Cardiology and Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Ascah
authors.affiliation: Division of Anatomical Pathology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: John P
authors.initials: JP
authors.lastname: Veinot
authors.affiliation: Divisions of Cardiology and Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Buu-Khanh
authors.initials: BK
authors.lastname: Lam
authors.affiliation: Divisions of Cardiology and Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: mfroeschl@ottawaheart.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Froeschl
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000175:diagnosis* / Q000628:therapy; D004452:Echocardiography; D004696:Endocarditis / Q000175:diagnosis*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000293:injuries* / Q000382:microbiology; D062645:Percutaneous Coronary Intervention; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging / Q000382:microbiology; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000628:therapy; D015607:Stents; D019210:Troponin I / Q000097:blood; D018615:Ultrasonography, Doppler, Color
chemical_list: D019210:Troponin I