A 26-Year-Old Pregnant Woman with Ventricular Tachycardia and Shock

This case report chronicles the diagnostic and management journey of a 26-year-old pregnant woman with ventricular tachycardia and cardiogenic shock at 32 weeks’ gestation with monochorionic twins. She developed leg edema and polyhydramnios before admission, then experienced progressive respiratory and leg symptoms. After sudden chest pain and cardiac arrest due to ventricular tachycardia, she underwent emergency cesarean delivery and was placed on venoarterial ECMO. Imaging revealed biventricular dilatation, pulmonary edema, pleural and pericardial effusions, and severely reduced left ventricular ejection fraction (11%). Coronary angiography showed caliber abnormalities in proximal coronary arteries, suggesting spontaneous coronary-artery dissection. Despite mechanical circulatory support including LVAD implantation, her ventricular function did not recover. Myocardial infarction was confirmed via pathology of the explanted heart after transplantation, with remote infarct evidence in the left ventricular walls. The final diagnosis was pregnancy-associated myocardial infarction secondary to spontaneous coronary-artery dissection.

This case report chronicles the diagnostic and management journey of a 26-year-old pregnant woman with ventricular tachycardia and cardiogenic shock at 32 weeks’ gestation with monochorionic twins. She developed leg edema and polyhydramnios before admission, then experienced progressive respiratory and leg symptoms. After sudden chest pain and cardiac arrest due to ventricular tachycardia, she underwent emergency cesarean delivery and was placed on venoarterial ECMO. Imaging revealed biventricular dilatation, pulmonary edema, pleural and pericardial effusions, and severely reduced left ventricular ejection fraction (11%). Coronary angiography showed caliber abnormalities in proximal coronary arteries, suggesting spontaneous coronary-artery dissection. Despite mechanical circulatory support including LVAD implantation, her ventricular function did not recover. Myocardial infarction was confirmed via pathology of the explanted heart after transplantation, with remote infarct evidence in the left ventricular walls. The final diagnosis was pregnancy-associated myocardial infarction secondary to spontaneous coronary-artery dissection.