Apparent End-Stage Heart Failure Forced Toward a Successful Myocardial Recovery

Background: Strategies to promote myocardial recovery from cardiogenic shock (CS) remain understudied. Case Summary: A 51-year-old woman with recently diagnosed heart failure (left ventricular ejection fraction <10%) presented in CS requiring milrinone and temporary mechanical circulatory support (t-MCS). Multimodality testing revealed no specific etiology, but cardiac positron emission tomography-flourodeoxyglucose imaging showed uptake in the colon. Biopsy was performed with tubulovillous adenoma with high-grade dysplasia necessitating colectomy/colostomy. Malignancy was excluded, but heart replacement therapy was deemed high risk due to colostomy. t-MCS was weaned, and inotropes were discontinued after months of guideline-directed medical therapy (guideline-directed medical therapy) titration. Current LVEF is in the range of 35% to 39%, and the patient remains ambulatory. Discussion: This case illustrates “forced recovery” via prolonged inotrope-supported guideline-directed medical therapy due to heart replacement therapy contraindications. Take-Home Messages: Native heart recovery is possible even in CS requiring t-MCS, emphasizing the need for individualized strategies. Research is needed to identify predictors of recovery and strategies for native heart recovery–focused approaches.