A multimodal approach including mechanical circulatory support (Impella and ECMO), IVIG, and corticosteroids successfully treated a case of fulminant myocarditis complicated by cardiogenic shock.
Supports multimodal therapy in fulminant myocarditis shock; leaves open need for controlled trials to guide practice.
Purpose: Myocarditis is an inflammatory process of the myocardium that can have an assortment of different etiologies such as infection, systemic disease and/or exposure to medications and toxins. There can be a variety of clinical presentations ranging from mild dyspnea and chest pain that can be self-limiting to cardiogenic shock and death. Although myocarditis can have several causes, viral infection remains the leading cause of both acute and chronic myocarditis. Corticosteroids, Intravenous Immunoglobulin (IVIG) and ventricular assist devices are controversial treatment options with minimal evidence of efficacy in the adult population.
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Calvin Tucker (2013) studied this question.
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