A case of shock after STEMI: Think beyond the cardiogenic one

Abstract

Acute ST-segment elevation myocardial infarction (STEMI) can typically complicate with the development of cardiogenic shock; nevertheless, other less frequent types of shock may occur, including adrenal crisis (AC). We describe a case of STEMI complicated by AC and, for the first time, AC-induced focal takotsubo syndrome.

Keywords: STEMI; acute adrenal insufficiency; adrenal crisis; cardiogenic shock; stress cardiomyopathy; takotsubo syndrome.

FIGURE 1

(A) ECG at Emergency Department. Negative and symmetrical T waves in leads DI, DII, aVL, aFV and from V2 to V6 and ST‐segment elevation of 2 mm in V3 and of 1 mm in V4 and V4 (red arrows). (B) ECG normalization after PCI. (C) ECG during shock. Sinus tachycardia with ST‐segment elevation of 1 mm in leads DI and DII and of 3 mm in leads V2 and V3. ST‐segment depression of 1 mm in lead aVR (red arrows)

FIGURE 2

(A) Coronary angiography: occlusion of the first tract of the LAD (red arrow) (caudal angulation). (B) Coronary angiography: occlusion of the first tract of the LAD (red arrow) (cranial angulation). (C) Coronary angiography after PCI: TIMI‐III flows of the LAD (red arrow) (caudal angulation). (D) Coronary angiography during shock: no AST nor coronary vasospasm (caudal angulation)