Case 30-2015: A 50-Year-Old Man with Cardiogenic Shock

A 50-year-old man with a history of cardiomyopathy and progressive muscle weakness was admitted with cardiogenic shock. Electroencephalography showed total suppression of cerebral activity; ventilator support was withdrawn, and he died. An autopsy was performed. Presentation of Case Dr. Todd Herrington (Neurology): A 50-year-old man was transferred to this hospital because of cardiogenic shock. A diagnosis of dilated nonischemic cardiomyopathy had been made when the patient was in his late 40s. When he was 48 years of age, a dual-chamber pacemaker and implantable cardioverter–defibrillator (ICD) was placed. Dr. Jodi L. Zilinski (Echocardiology): Four months before admission, transthoracic echocardiography revealed a left ventricular ejection fraction of 40% (Figure 1A, 1B, and 1C; and Videos 1 and 2, available with the full text of this article at NEJM.org). Dr. Herrington: Several days before admission, malaise, fatigue, increasing dyspnea, and chest . . .