Why the study?
Fulminant lymphocytic myocarditis carries a poor prognosis with cardiogenic shock, and reports on management using concomitant mechanical circulatory support are limited.
Does the concomitant use of IABP and V-A ECMO improve outcomes in patients with fulminant lymphocytic myocarditis and cardiogenic shock?
Does the concomitant use of IABP and V-A ECMO improve outcomes in patients with fulminant lymphocytic myocarditis and cardiogenic shock?
Concomitant use of IABP and V-A ECMO may provide survival benefits and facilitate cardiac recovery in patients with fulminant lymphocytic myocarditis complicated by severe cardiogenic shock.
Case of fulminant LM with cardiogenic shock; leaves open optimal strategies beyond standard inotropes and mechanical support.
BACKGROUND Lymphocytic myocarditis (LM) is a rare inflammatory disease of the heart. The clinical presentation of LM varies from mild flu-like symptoms to fulminant myocarditis with cardiogenic shock. Fulminant myocarditis has a poor prognosis and the usual treatment is inotropes with or without ventricular assist devices such as intra-aortic balloon pump (IABP) and venoarterial extracorporeal membrane oxygenation (V-A ECMO). We report the case of fulminant LM with severe cardiogenic shock that was successfully treated with concomitant use of IABP and V-A ECMO. CASE REPORT A 32-year-old woman with no medical history presented to the Emergency Department (ED) with chest pain with irradiation to the left upper limb, worse when supine. The electrocardiogram (ECG) on admission showed sinus rhythm with nonspecific ST-T repolarization abnormalities, and laboratory results showed elevated ultrasensitive troponin and C-reactive protein. Transthoracic echocardiography (TTE) showed left ventricular ejection fraction (LVEF) of 25% and diffuse hypokinesis. On the next day, she developed cardiogenic shock requiring vasoactive drugs, IABP, and V-A ECMO. Pulse therapy with methylprednisolone was started. Endomyocardial biopsy (EMB) revealed acute LM, and intravenous human immunoglobulin was administered. The patient evolved with progressive clinical improvement, being discharged 56 days after admission, with an improvement in the LVEF to 55%. CONCLUSIONS Fulminant LM is a rare and potentially fatal condition that requires immediate intervention. The combination of IABP and V-A ECMO among patients with LM-cardiogenic shock may provide survival benefits.
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Araujo et al. (2023) studied this question.
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