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Washington University Experience | VASCULAR | Infarct - Lacunar | 13A0 Case 13 History
Case 13 History ---- The patient was a 66-year-old woman with a past medical history significant for coronary artery disease with myocardial infarction in 2014 and subsequent coronary stent placement, peripheral arterial disease status post multiple lower-extremity vascular interventions including stenting and right femoropopliteal bypass (2024), heart failure with reduced ejection fraction (35%, April 2026), chronic kidney disease, hypertension, type 2 diabetes mellitus, and tobacco use. In June 2026, she developed acute respiratory distress followed by cardiopulmonary arrest. Emergency Medical Services initiated resuscitation in the field and achieved return of spontaneous circulation, after which she was endotracheally intubated. Upon arrival at the Emergency Department, she was unresponsive, hypotensive and borderline bradycardic. Her clinical course remained tenuous and she continued profoundly hemodynamically unstable with recurrent pulseless electrical activity/asystolic arrest despite prolonged resuscitative efforts. Bedside echocardiography reportedly showed severe global cardiac akinesis progressing to absence of cardiac activity. Despite advanced cardiac life support measures, including vasopressor support and prolonged cardiopulmonary resuscitation, resuscitative efforts were unsuccessful, and she passed away.
