Abstract
An 80-year-old woman was brought to the emergency room with acute coronary syndrome-induced cardiogenic shock. She underwent emergency catheterization, following which she was managed in the intensive care unit with ventilatory support, intra-aortic balloon pumping (IABP), and inotropic drugs. She continued to have prolonged cardio-genic shock in the postoperative period. A systolic murmur was heard at the left sternal margin in the fourth intercostal space. An echocardiography showed a sigmoid septum and accelerated blood flow in the left ventricular outflow tract, suggesting a tract obstruction (LVOTO). Therefore, IABP and inotropic drugs were discontinued, following which her hemodynamics improved. A repeat echocardiography showed no evidence of accelerated blood flow or pressure gradient in the left ventricular outflow tract despite the presence of a sigmoid septum. In conclusion, an elderly woman with a sigmoid septum suffered a myocardial infarction that caused compensatory basal wall motion in the heart, resulting in dynamic LVOTO. The use of IABP and inotropic drugs increased the pressure gradient in the left ventricular outflow tract, exacerbating her altered hemodynamics.
