An unexpected cause of post-operative shock

A 66-year-old woman, admitted for day-case laser excision of a T1N0 laryngeal squamous cell carcinoma, suddenly became dyspnoeic while in the recovery ward ∼20 min after successful completion of an uneventful procedure. Arterial blood gas analysis confirmed acute type II respiratory failure which prompted emergency re-intubation, initiation of ventilatory support and transfer to the intensive care unit. A portable chest X-ray showed bilateral alveolar filling defects consistent with severe pulmonary oedema and on 12-lead electrocardiogram (ECG), 1 mm of new ST segment elevation across leads V2–V4 was noted. Progressively worsening hypotension necessitated the initiation of inotropic support. Although the patient was not known to have ischaemic heart disease, her pro-atherosclerotic risk factors included current cigarette smoking, type 2 diabetes mellitus, hypertension and dyslipidaemia. Accordingly, an acute coronary syndrome (ACS) …