VASOPRESSIN-INDUCED ST-ELEVATION MYOCARDIAL INFARCTION

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Vasopressin is commonly used to restore blood pressure in hyperdynamic hemodynamic states, thereby reducing catecholamine requirements. The effects of vasopressin are primarily caused by the rise mean arterial (MAP) due systemic vasoconstriction, which, depending on infusion rate, can also produce notable vasoconstrictive coronary microvasculature flow despite an increase perfusion pressure. Here we present interesting case vasopressin-induced ST-elevation myocardial infarction (STEMI) postoperative day two cardiac catheterization for initial STEMI. CASE PRESENTATION: A 67-year-old male with a past medical history hypertension, hypothyroidism presented emergency department (ED) complaint left shoulder pain. In ED waiting room, patient suddenly collapsed losing consciousness, and was found be arrest. ACLS protocol immediately started ROSC achieved. An electrocardiogram (EKG) performed which showed STEMI anterolateral leads. Code activated, taken where LAD stenosis observed stented. Post-procedure, transferred Cardiac ICU, amiodarone drip initiated recurrent episodes non-sustained ventricular tachycardia. hospital course further complicated pneumonia leading acute hypoxemic respiratory failure septic shock. placed norepinephrine appropriate antibiotics. added reduce requirements achieve target MAP. On two, noted have ST elevation tele monitor, twelve lead EKG confirmed anteroseptal heart revealed patent stent no new findings recommendations were made stop continue rest treatment. successfully extubated BiPAP, eventually slow steady recovery, discharged home follow-up appointments. DISCUSSION: It has been shown that levels as part stress response, exert arteries mainly non-epicardial vessels microcirculation. These high states like phenomenon mediating ischemia-perfusion injury. CONCLUSIONS: advanced distributive shock accompanied cardiogenic state, utmost caution should vasoconstrictor properties not positive inotropic qualities, may depress function even result impaired increased artery severe cases ischemia. REFERENCE #1: Nobian A, Mohamed Spyridopoulos I. role arginine reperfusion. Kardiol Pol. 2019 Oct 25;77(10):908–17. #2: Hauser B, Asfar P, Calzia E, Laporte R, Georgieff M, Radermacher P. vasodilatory shock: danger? Crit Care. 2008;12(2):132. #3: ischaemic disease: more than vasoconstriction? 2009;13(4):169. DISCLOSURES: No relevant relationships Mohammed Ali, source=Web Response Humayun Anjum, Rahul Dadhwal, Salim Surani,