CardioNerds discuss a case of obstructive cardiogenic shock in a 42-year-old woman with Tetralogy of Fallot repair. They highlight lactic acidosis, kidney injury, NT-proBNP elevation, and moderate biventricular dysfunction. The patient had right heart catheterization showing elevated pressures and low cardiac index. Intracardiac echocardiography revealed a large mass within the valve apparatus, prompting further evaluation and management.