CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 3, May/June 2011
AFRICA
145
Cardiogenic shock in an elderly man caused by left main
coronary artery occlusion with spontaneous dissection
of right coronary artery
CAN YUCEL KARABAY, GONENC KOCABAY, ARZU KALAYCİ, REGAYIP ZEHİR, MERAL MERT, CEVAT KİRMA
Summary
We present a case of an 85-year-old man with acute myocar-
dial infarction and cardiogenic shock due to left main coro-
nary artery occlusion, with spontaneous dissection of the
right coronary artery.
Keywords:
cardiogenic shock, left main coronary artery occlu-
sion, spontaneous dissection of right coronary artery
Submitted 20/5/10, accepted 30/6/10
Published online 10/12/10
Cardiovasc J Afr
2010;
22
: 145–146
DOI: CVJ-21.036
Acute myocardial infarction due to occlusion of the unprotected
left main coronary artery (LMCA) (where none of the distal
arteries is protected by a graft or good collaterals) is a rare clini-
cal entity.
1
Cardiogenic shock or pulmonary oedema due to pump
failure or refractory ventricular arrhythmias are causes of death
in this condition,
2
therefore, reperfusion must be done quickly to
prevent serious consequences.
1,2
Case report
An 85-year-old man was admitted to our emergency depart-
ment with cardiogenic shock secondary to an acute myocardial
infarction (AMI). The electrocardiogram showed acute anterior
myocardial infarction with left bundle branch block. On admis-
sion, his blood pressure was 70/40 mmHg and bibasiller rales
suggested Killip classification 4. He required an intra-aortic
balloon pump (IABP) for haemodynamic support and mechani-
cal ventilation for respiratory support.
Echocardiography on admission displayed anterior, apex and
anteroseptum akinesia and severely impaired left ventricular
function. His ejection fraction was 30% with moderate mitral
regurgitation. He was taken to the laboratory for emergency
cardiac catheterisation. Coronary angiography revealed complete
thrombotic occlusion of the LMCA with TIMI flow of 0 through-
out the left coronary system (Fig. 1), and spontaneous coronary
Kartal Kosuyolu Yuksek Ihtisas Heart Education and
Research Hospital, Department of Cardiology, Istanbul,
Turkey
CAN YUCEL KARABAY, MD
GONENC KOCABAY, MD,
ARZU KALAYCİ, MD
REGAYIP ZEHİR, MD
CEVAT KİRMA, MD
Kayseri Educational and Research Hospital, Department of
Endocrinology and Metabolism, Kayseri, Turkey
MERAL MERT, MD
dissection of the right coronary artery (RCA) with TIMI flow of
2 (Fig. 2).
Prompt percutaneous transluminal coronary angioplasty
under tirofiban and heparin cover to the occluded LMCA was
done with a 3.5
×
15-mm Sprinter RX balloon (Medtronic,
Fig. 1. Angiogram showing complete occlusion of the
distal LMCA with TIMI flow of 0 throughout the left coro-
nary system.
Fig. 2. Subtotal obstruction due to spontaneous coronary
dissection of the right coronary artery.
