Abstract 15886: When the Giant is Hidden but Not Dormant
| Autor: | Koji Takeda, Amirali Masoumi, Gabriel Sayer, Estefania Oliveros, Rachel Bijou, Nir Uriel, Yevgeniy Brailovsky |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Myocarditis business.industry Cardiogenic shock High index Extracorporeal circulation medicine.disease Ventricular tachycardia Transplantation Physiology (medical) Internal medicine Circulatory system medicine Cardiology Etiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 142 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circ.142.suppl_3.15886 |
| Popis: | Background: Giant cell myocarditis is a rare etiology of cardiogenic shock, which requires high index of suspicion, rapid immunosuppressive therapy, and sometimes mechanical circulatory supportCase presentation69 year old woman with prior medical history of non-ischemic dilated cardiomyopathy and recovered left ventricular ejection fraction (LVEF) presented with cardiogenic shock complicated by acute renal and liver injury requiring support with Impella 5.5. Suspicion for myocarditis was high and patient underwent endomyocardial biopsy and started on high dose steroids. Biopsy was negative for myocarditis. Despite support, patient had progressive shock and incessant ventricular arrhythmia necessitating IV antiarrhytmics and escalation to VA ECMO in addition to Impella and eventually to central Centrimag BiVAD with drainage cannulas in right atrium and LV apex, and reinfusion catheters in pulmonary artery and ascending aorta. (Figure 1) She was urgently listed for heart transplantation as a status 1 and one day later underwent successful orthotopic heart transplantation. Pathological examination of the explanted heart was consistent with Giant cell Myocarditis (Figure 2) Conclusion: Giant cell myocarditis is a rare etiology of cardiogenic shock. Suggestive features include rapid hemodynamic deterioration and incessant ventricular arrhythmia. Negative initial endomyocardial biopsy is not enough to rule out the disease in high clinical suspicion. Rapid escalation of support is warranted in fulminant cases to preserve end organ function and improve survival.(Figure 1 Created with BioRender.com) |
| Databáze: | OpenAIRE |
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