Troponin positiver kardiogener Schock bei einem 73-jährigen Patienten

摘要

Cardiogenic shock presents an enormous challenge in intensive care medicine due to its high mortality. The most common cause is a left ventricular pump failure (80%), but it is important to consider mechanical complications as differential-diagnostic options. A 73-year-old male was admitted to the intensive care unit because of a progressive pulmonary edema with a two-hour history of severe chest pain and an anamnestic known coronary heart disease. After admission, catecholamine-dependent cardiogenic shock developed rapidly with the need for intubation and mechanical ventilation. The electrocardiography showed unspecific changes, the laboratory values were consistent with a myocardial infarction. After clinical stabilization, an emergency coronary angiography was performed. No stenosis of the coronary arteries was found. After return to the ICU, a transthoracic and a transesophageal echocardiography were performed. An anterolateral papillary muscle rupture was detected, which was the cause of the cardiogenic shock. An emergency biological mitral valve replacement was performed immediately. In spite of the good operation result, the patient died because of a multiple organ failure on the first postoperative day. Conclusion In intensive care medicine, echocardiography is a decisive tool in cardiologic diagnostics. The examination is safe, well tolerated and can be used at the bed side. Our case report underlines the outstanding importance of echocardiography in differential-diagnosis and therapeutic management of cardiogenic shock. The exact diagnosis could be assured rapidly with the help of the echocardiography. Thus, the patient could be treated adequately.