Spontaneous Recovery From Cardiogenic Shock And Renal Failure
American Journal of Medicine 78(5): May 1985; 878-880
View Original Source →Abstract
A patient is described with an unexpected and spontaneous recovery from cardiogenic shock and acute severe oliguric renal failure despite her refusal to receive appropriate therapeutic action. The uniqueness of this patient’s course and the need to individualize ethical decisions are emphasized.
Case Details
Personal Characteristics
57-year-old woman
Clinical Characteristics
Presented with an acute anterior myocardial infarction, right bundle branch block with left axis deviation, ventricular fibrillation, acute hypotension, electromechanical dissociation, renal shutdown, marked oliguria, azotemia, confusion, agitation, anuria, incontinence, confusion but alert conversation, easy fatigability, dyspnea on exertion, angina
Remission Characteristics
Awake and quickly returned to her normal neurologic baseline, systolic blood pressure remained at the 80 to 90 mmhg range, urine output of 50 ml/hour, recovered her baseline mental status, electrolyte values displayed continual improvement, systolic blood pressure was in the range of 90 to 100 mmhg, radionuclide left ventricular ejection fraction was 40%, slow improvement in exercise tolerance, return of the patient's renal function to pre-hospitalization levels
Treatment & Mechanisms
Proposed Remission Mechanisms
Not discussed
Clinical Treatment
Placement of a sequential aortocoronary bypass graft, cardiac catheterization, intracoronary thrombolysis, placement of a temporary transvenous pacemaker, cardiopulmonary resuscitation, intracardiac injections of calcium chloride and epinephrine, dopamine support, foley catheterization, oral fluid administration, propranolol and nitroglycerin ointment
Non-Clinical Treatment
Supportive care, small doses of morphine sulfate and hydroxyzine
Additional Notes
The patient declined peritoneal dialysis and disconnected all of her intravenous lines. She was transferred to a non-monitored room for supportive care. No laboratory values were monitored during her anuric period.