A Case Of Cardiogenic Shock That Highlights The Importance And Limitations Of Point-Of-Care Transthoracic Echocardiography In The Emergency Department

Point-of-care transthoracic echocardiogram (POCTE) is a valuable tool for emergency physicians (EPs) to evaluate for etiologies of shock in patients presenting with ST-segment elevation myocardial infarction (STEMI) on electrocardiogram. Potential etiologies of shock include acute left or right ventricular failure, acute severe mitral valve regurgitation, or cardiac tamponade resulting from left ventricular free wall rupture or ascending thoracic aortic dissection. Typical management of STEMI, including emergent cardiac catheterization with angioplasty, stenting, and/or thrombolytics, may have disastrous consequences in some of these cases. We present a case of an elderly male with STEMI complicated by cardiogenic shock who had an acute coronary artery occlusion, papillary muscle rupture with acute severe mitral regurgitation, and an unexpected unifying diagnosis. This case simultaneously highlights the utility of POCTE to guide the EP’s immediate management of concurrent STEMI and shock while cautioning against over-interpretation of POCTE beyond the scope of its focused assessment.