Early cardiac rehabilitation supported by levosimendan infusion and mitral valve repair in acute myocardial infarction complicated by cardiogenic shock

Background: Patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock and severely reduced left ventricular ejection fraction (LVEF) face extremely poor prognosis, particularly elderly patients. Early initiation of cardiac rehabilitation is often limited by haemodynamic instability. Case summary: A 75-year-old man with anterior STEMI treated with primary percutaneous coronary revascularization experienced multiple complications including cardiogenic shock, multiorgan dysfunction, persistent ventricular arrhythmias and severe mitral regurgitation (MR). Via a strong collaboration between a tertiary cardiac centre and rehabilitation facility, recurrent decompensation was treated with early administration of ino-dilators, mitral transcatheter edge-to-edge repair (M-TEER) and a tailored cardiac rehabilitation programme, providing net improvement in clinical stability, functional capacity and subsequent clinical outcomes. Conclusion: This case highlights the potential role of early haemodynamic stabilization with levosimendan, M-TEER and multidisciplinary rehabilitation in improving functional outcomes, even in high-risk elderly patients with STEMI complicated by cardiogenic shock and severely reduced LVEF.