Cardiogenic shock is the most common cause of death in patients hospitalized with acute myocardial infarction and is associated with a poor prognosis. More than 75% of cases are due to extensive left ventricular infarction and ventricular failure. Other causes include right ventricular infarction and papillary muscle rupture with acute severe mitral regurgitation. Activation of neurohormonal systems and the systemic inflammatory response worsens shock. To improve outcomes, cardiogenic shock needs to be recognized early in its course and its cause needs to be diagnosed rapidly. Treatment strategies using intra-aortic balloon counterpulsation and emergency revascularization by percutaneous coronary interventions or coronary bypass surgery have been shown to improve outcomes. To decrease the incidence of cardiogenic shock, public education regarding early presentation to hospital in the course of acute chest pain is important. Emergency medical transport systems may need to take patients with complicated acute myocardial infarction to hospitals with the capability to perform urgent revascularization.

Pulmonary artery rupture (PAR) is a rare but deadly complication (incidence of 0.03-0.2% of all PA cannulations), with mortality in the region of 70%. We report a case of an 88-year-old woman with iatrogenic PAR as a result of Swan-Ganz catheter placement. A rapid successful isolation and occlusion of the culprit PA branch via the deployment of an Amplatzer Vascular Plug (AGA Medical Corporation, North Plymouth, MN) was performed. To our knowledge, this is the first case report where this device has been used as therapy in PAR.

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