Abstract 11430: A Bad Break: Cardiogenic Shock Complicated by an Intracardiac Foreign Body

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Introduction: We report a case of cardiogenic shock complicated by an intracardiac foreign body. This is a rare occurrence during a dangerous cardiovascular disease process which necessitated urgent multidisciplinary management. Case: A 54-year-old female with a history of hypertensive cardiomyopathy and breast cancer was not improving during a hospitalization for acutely decompensated CHF and atrial flutter with RVR. Right heart catheterization demonstrated cardiogenic shock, with a foreign body noted in the right atrium favored to be a fragment of the left subclavian port catheter also seen on fluoroscopy. This object was present on admission imaging but likely mistaken as external artifact. Coronary angiography revealed severe multi-vessel CAD. A multidisciplinary team discussed the timing and modality of foreign body removal, electing to prioritize hemodynamic optimization before intervention. Once stable, the patient underwent successful endovascular removal of the catheter fragment with immediate improvement of her heart rhythm. She remained in sinus rhythm until discharge home in stable condition. Discussion: This episode of cardiogenic shock may have been precipitated by an arrhythmogenic intracardiac foreign body. However, medication non-adherence and severe CAD on angiography suggested a multifactorial etiology, justifying a delay in the removal of the foreign body until shock had resolved. Additionally, the catheter fragment present on admission imaging should have been identified earlier as a contributing factor. Timely recognition and removal of the fragment may have prevented the hemodynamic decompensation of the patient. Conclusion: This case demonstrates the efficacy of delaying the removal of an intracardiac foreign body in favor of hemodynamic optimization in patients with cardiogenic shock, while obviating the need for maintaining a broad differential when determining the underlying etiology of decompensated heart failure.

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