Abstract 15207: An Unusual, Reversible Cause of Acute High-Output Heart Failure Complicated by Refractory Shock

A 52 year-old man with no medical history presented with one week of fatigue and two days of intermittent substernal chest pain and dyspnea that began while doing construction. Upon arrival to the emergency room, he was hypotensive and tachypneic with normal mental status, elevated JVP, crackles, and warm extremities. Labs were notable for WBC 25, creatinine 2.5, troponin 7.4, lactic acidosis, and brain-natriuretic peptide 1924. ECG had T-wave inversions inferiorly; TTE revealed mildly reduced LV function with inferolateral hypokinesis. CXR confirmed pulmonary edema, and he was intubated. Cardiac catheterization revealed RAP 16, mean PA 35, LVEDP 25, high CO (12 L/min), low SVR (327 dynesseccm), no shunt, and mild CAD. After ruling out thyroid and liver disease, the leading diagnosis was septic shock.He remained mechanically ventilated with minimal support. CRRT was initiated for anuric renal failure. He developed anisocoria, cranial nerve VI palsy, and cranial nerve III paresis. Despite maximal doses of four vasopressors, he remained in shock (RAP>10, PCWP>20, CO>10, SVR