Emergency Alcohol Septal Ablation for Cardiogenic Shock in Obstructive Hypertrophic Cardiomyopathy.

BACKGROUND

Left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) can result in severe cardiovascular complications, including the rare and life-threatening scenario of cardiogenic shock.

CASE SUMMARY: A 74-year-old patient with advanced HCM presented with acute hemodynamic decompensation due to severe LVOTO. The patient was successfully managed with emergency alcohol septal ablation (ASA), resulting in rapid stabilization and symptom resolution.

DISCUSSION: This case underscores the critical role of emergency ASA as an effective, minimally invasive treatment for high-risk patients with HCM with acute hemodynamic instability, especially when conventional surgical options are not feasible. The subsequent use of mavacamten further contributed to sustained improvement, highlighting the role of combined procedural and pharmacologic therapies in optimizing patient outcomes.

TAKE-HOME MESSAGES: Emergency ASA is an effective, minimally invasive intervention for managing acute LVOTO in high-risk patients with HCM. Adjunctive use of mavacamten after ASA can further improve outcomes, highlighting the importance of combining procedural and pharmacologic therapies in managing high-risk HCM.