Abstract
A 58-year-old man was transferred to our hospital because of multiple organ dysfunction and myocardial infarction. He had been complaining of vomiting, diarrhea and malaise for 3 days before admission. On examination his vital signs were stable. Laboratory data showed severe kidney and liver dysfunction as well as disseminated intravascular coagulation. Electrocardiography and echocardiography showed evidence of inferior and right ventricular myocardial infarction. Coronary angiography showed total occlusion of the proximal segment of the right coronary artery and 75% stenosis of the left main trunk. There were no symptoms or physical finding suggesting shock. After initiation of intra-aortic balloon pumping and continuous hemodiafiltration, his multiple organ dysfunction improved rapidly. He underwent coronary artery bypass grafting on the 7th hospital day and was discharged on the 39th hospital day. It was suggested that low cardiac output due to right ventricular infarction and left ventricular dysfunction dehydration gradually caused his multiple organ dysfunction in the absence of sign of cardiogenic shock. Clinicians should remember the potential for atypical presentation of cardiogenic shock, especially due to right ventricular dysfunction.
