Acquired left ventricular outflow tract obstruction and cardiogenic shock treated with beta-blockers.

Beta-blockers are normally contraindicated in the treatment of cardiogenic shock. A 70-year-old lady presents with an acute coronary syndrome complicated by critical cardiogenic shock. Coronary angiography shows an ulcerated nonobstructing plaque in the left anterior descending artery. She fails to improve with standard treatment with inotrope and intraaortic balloon pump. Echocardiography revealed acquired left ventricular outflow tract (LVOT) obstruction and secondary mitral regurgitation. Treatment with intravenous beta-blockers produced both clinical and hemodynamic improvement as well as resolution of LVOT obstruction. Echocardiography is essential in defining the mechanism of cardiogenic shock in patients with acute coronary syndrome. Inotropic support exacerbates cardiogenic shock due to acquired LVOT obstruction that is best treated with beta-blockers.