Intra-aortic Balloon Pump Induced Dynamic Left Ventricular Outflow Tract Obstruction and Cardiogenic Shock: A Case Report

We present a complex case of a 50-year-old man who presented with inferior ST-elevation myocardial infarction and cardiogenic shock. Our patient presented with out-of-hospital ventricular fibrillation cardiac arrest. Cardiopulmonary resuscitation was promptly started and return of spontaneous circulation was achieved. The patient underwent urgent coronary angiography with implantation of drug-eluting stent in his right coronary artery. Intra-aortic balloon pump was inserted. However, this was complicated by worsening of left ventricular outflow tract obstruction and systolic anterior motion of mitral valve leaflet. He was successfully weaned off balloon pump, inotropes and liberated from mechanical ventilation. To our knowledge, this is the first case reported of balloon pump associated left ventricular outflow tract obstruction in a setting of inferior myocardial infarction. This case illustrates the importance of early removal of balloon pump and precise use vasopressor in instituting the stepwise treatment modalities leading to a favourable outcome. CaSe RePORt