Cardiogenic shock following administration of propofol and fentanyl in a healthy woman: a case report

Abstract

Introduction: Cardiogenic shock is very uncommon in healthy people. The differential diagnosis for patients with acute heart failure in previously healthy hearts includes acute myocardial infarction and myocarditis. However, many drugs can also depress myocardial function. Propofol and fentanyl are frequently used during different medical procedures. The cardiovascular depressive effect of both drugs has been well established, but the development of cardiogenic shock is very rare when these agents are used.

Case presentation: After a minor surgical intervention, a 32-year-old Caucasian woman with no significant medical history went into sudden hemodynamic deterioration due to acute heart failure. An urgent echocardiogram showed severe biventricular dysfunction and an estimated left ventricular ejection fraction of 20%. Extracorporeal life support and mechanical ventilation were required. Five days later her ventricular function had fully recovered, which allowed the progressive withdrawal of medical treatment. Prior to her hospital discharge, cardiac MRI showed neither edema nor pathological deposits on the delayed contrast enhancement sequences. At her six-month follow-up examination, the patient was asymptomatic and did not require treatment.

Conclusion: Although there are many causes of cardiogenic shock, the presence of abrupt hemodynamic deterioration and the absence of a clear cause could be related to the use of propofol and fentanyl.

Figure 1

Ecocardiographic images: (A) Transthoracic echocardiogram showing severe left ventricular dysfunction. (B) Normal LVEF after total recovery.

Figure 2

Cardiac-MRI images: (A) Cardiac MRI gradient echo sequence showing normal dimensions and function of the left ventricle. (B) T2-weighted short τ inversion recovery sequence showing the absence of edema. (C) Late gadolinium hyperenhancement sequence without pathological contrast captation.