Ejection fraction - A number to be interpreted with caution!

Cardiogenic shock is frequently seen following acute myocardial infarction complicated by the rupture of interventricular septum and formation of functional ventricular septal defect. Despite significant advances in medical, interventional and surgical management, the mortality in this group of patients remains very high. We present a case of refractory cardiogenic shock following an exclusion bovine pericardial patch repair of post infarction ventricular septal defect, where the residual functional left ventricular cavity size was insufficient to maintain end organ function. This case illustrates the concept of "Normal ejection fraction low cardiac output cardiogenic shock", where reporting left ventricular ejection fraction number in isolation can be misleading.