Fulminant Cardiogenic Shock Research Articles

Recurrent Myopericarditis and Fulminant Cardiogenic Shock Due to Autoimmune Polyglandular Syndrome 2

A 34-year-old man presented with acute pericarditis and a small pericardial effusion but rapidly decompensated into cardiac tamponade and fulminant cardiogenic shock, requiring venoarterial extracorporeal membrane oxygenation cannulation. He was diagnosed with autoimmune polyglandular syndrome 2 and was treated with stress dose steroids and an interleukin-1 inhibitor, with improvement in his cardiac function.

Severe COVID-19-associated myocarditis with cardiogenic shock – management with assist devices – a case report & review

BackgroundPrimary viral myocarditis associated with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infection is a rare diagnosis.Case presentationWe report the case of an unvaccinated, healthy patient with cardiogenic shock in the context of a COVID-19-associated myocarditis and therapy with simultaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and percutaneous left ventricular decompression therapy with an Impella. The aim of this review is to provide an overview of therapeutic options for patients with COVID-19-associated myocarditis.ConclusionsThe majority of patients required a combination of two assist devices to achieve sufficient cardiac output until recovery of left ventricular ejection fraction. Due to the rapid onset of this fulminant cardiogenic shock immediate invasive bridging therapy in a specialized center was lifesaving.

Prevalence and Clinical Implications of COVID-19 Myocarditis.

The clinical manifestations of COVID-19 are widely variable and may involve several districts. Although the clinical course is mostly characterized by respiratory involvement, up to 30% of hospitalized patients have evidence of myocardial injury due to acute coronary syndrome, cardiac arrhythmias, myocarditis, and cardiogenic shock. In particular, myocarditis is a well-recognized severe complication of COVID-19 and is associated with fulminant cardiogenic shock and sudden cardiac death. In this article, the authors aim to present a comprehensive review about COVID-19-related myocarditis, including clinical characteristics, diagnostic workup, and management.

Fulminant Myocarditis in Fontan Patient Treated with Mechanical Circulatory Support and Heartmate 3

Introduction Cardiogenic shock is a rapidly progressive condition associated with high mortality, often necessitating the use of mechanical circulatory support. Single ventricle physiology with Fontan presents many unique anatomical and hemodynamic challenges, and there is limited published experience with left ventricular assist devices (LVAD) in this population. Case Report A 30 year old female with pulmonary atresia with intact ventricular septum and lateral tunneled Fontan presented with chest pressure followed by sustained ventricular tachycardia (VT). Her echo demonstrated severely reduced left ventricular (LV) function with ejection fraction of 15-20%. Endomyocardial biopsy showed lymphocytic myocarditis, and she was treated with pulse steroids and IVIG. Given worsening shock and multiorgan failure with rapid vasopressor escalation, she was placed on femoral VA ECMO with Impella CP for venting. She eventually had LV apical cannulation and aortic graft via an upper hemisternotomy and left thoracotomy as a left ventricular assist device (KVAD). Her course was notable for persistent VT, shock liver, and renal failure requiring dialysis. After 3 weeks of mechanical support, she demonstrated recovery in end organ function and normalization of mental status, allowing for extubation and physical therapy. Given her high BMI and inability to list for a heart transplant, she underwent successful implant of a Heartmate 3 LVAD (via the original left thoracotomy using the previously placed aortic graft). Despite repeatedly negative surveillance and preoperative COVID19 tests following her initial recovery, postoperatively she developed de novo COVID19 infection complicated by respiratory failure, vasodilatory shock, renal failure, complement deposition, inflammatory storm, and concern for Fontan thrombosis. Despite aggressive treatment, she passed away from her COVID19 complications. Summary We present a case of fulminant cardiogenic shock due to lymphocytic myocarditis in a patient with Fontan physiology that was bridged with VA ECMO and KVAD and eventually received a Heartmate 3. Unfortunately, she passed away from de novo COVID19 infection. This case highlights several unique aspects such as the management of profound cardiogenic shock in complex congenital heart disease and the use of mechanical support in single ventricle Fontan physiology.

33-Year-Old Woman With Postpartum Acute Shortness of Breath

33-Year-Old Woman With Postpartum Acute Shortness of Breath

Cardiogenic shock secondary to phaeochromocytoma: adrenalectomy on multiple mechanical circulatory support devices

Introduction Phaechromocytoma is a neuroendocrine tumour of the chromaffin cells of the adrenal medulla. Tumours secrete catecholamines and typically present with hypertensive crisis or, in rare circumstances, cardiogenic shock. Case Presentation A 33 year old male presented with hypertensive crisis and fulminant cardiogenic shock. He required mechanical ventilation for hypoxaemia secondary to acute pulmonary oedema. A CT aortogram was performed for presumed aortic dissection which revealed a necrotic, enhancing adrenal mass. Due to severe left ventricular dysfunction, he was referred to our hospital for mechanical circulatory support (MCS). Peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was established in the referral hospital and he was transferred to our intensive care unit. An Impella-CP was then inserted to offload an increasingly dilated left ventricle. Hypertensive crises continued to occur despite maximum medical therapy, and it was determined the only viable option to control these paroxysms of hypertension was to perform adrenalectomy. Surgery was successfully performed whilst on dual MCS devices (VA-ECMO and Impella). Preoperatively the patient had intravenous alpha and beta adrenoceptor blockade and fluid status was optimised to address the chronic circulating volume depletion. Glucose and electrolyte imbalances were corrected. Intra-operative management focused on blood pressure control, heart rate and arrhythmia control. Agents that induce catecholamine release were avoided and tumour manipulation was minimised. Hypotension after tumour removal was anticipated and developed relatively quickly requiring infusions of noradrenaline, adrenaline and vasopressin to support an adequate arterial pressure. His post-operative recovery was initially favourable and myocardial function had improved to the point of planning ECMO explanation. Despite cardiovascular stability the patient suffered a catastrophic intracranial haemorrhage and treatment was withdrawn. Discussion Cardiogenic shock secondary to phaeochromoctyoma can be difficult to manage and has high mortality. The evolution of short to medium term MCS devices has provided clinicians with additional therapeutic options to manage refractory cases of this uncommon cause of cardiogenic shock. The authors hope this case will add to an expanding library of practice of using MCS in phaeochromocytoma.

Percutaneous biventricular Impella support in therapy-refractory cardiogenic shock

IntroductionPercutaneous mechanical circulatory support systems have increasingly been adopted as a bail out strategy in patients with cardiogenic shock. Since studies showed mostly mixed results, however, the use of support systems remains a case by case decision. CaseHere, we report on a case of therapy-refractory cardiogenic shock due to acute myocardial infarction treated with percutaneous right and left ventricular assist devices (Impella RP and CP). ConclusionDue to myocardial stunning, even patients with fulminant cardiogenic shock have the potential for full recovery. In the present case, we demonstrate the feasibility of biventricular Impella support in therapy-refractory cardiogenic shock facilitating bridge to recovery.

Reversible Heart Failure as a Result of Newly Diagnosed Primary Adrenal Insufficiency

ABSTRACT Objective: We report a case of primary adrenal insufficiency which presented with a rare finding of fulminant cardiogenic shock that improved with hydrocortisone administration. The presentation, clinical manifestations, laboratory results, radiologic findings, and management of a patient that developed cardiogenic shock as the result of an Addisonian crisis are described. Pertinent literature, physiology, and management are discussed. Methods: A 21-year-old male with a 1-year history of nausea and dizziness presented with a 3-day history of malaise, sore throat, fever, and weakness. The patient was hypotensive and was admitted to a local hospital for possible septic shock with low ejection fraction (EF). The patient subsequently developed a rapidly progressive cardiogenic shock requiring intubation and placement of biventricular assist devices. Results: The patient was diagnosed with adrenal insufficiency after mental status change and persistent cardiogenic shock. Stress-dose steroids were init...

Pheochromocytoma Presenting as Fulminant Cardiogenic Shock following Maltiple Organ Failure

Pheochromocytoma is an endocrine tumor classically presenting with headache, paroxysmal hypertension, and palpitations, which is often undiagnosed when cardiovascular complications, such as acute heart failure, myocardial infarction, angina pectoris, arrhymias, and dilated cardiomyopathy, presented as the initial clinical manifestations. Failure to identify a pheochromocytoma in these situations may be fatal. We discuss the case of a female, presenting with acute heart failure and cardiogenic shock requiring stabilization with ionotropes and vasopressors. Echocardiography revealed severe global hypokinesia of the dilated left ventricle. Pheochromocytoma was diagnosed by CT scan, as well as urine and plasma metanephrines. After the patient recovered with intensive medical treatment, the patient underwent adrenalectomy without complications. Follow-up echocardiography revealed normalized cardiac function and chamber dimensions. Despite the rarity of the tumor, this case demonstrates the utility of evaluating for pheochromocytoma, as it may identify a reversible cause of cardiomyopathy.

Facilitated cardiac recovery in fulminant myocarditis: pediatric use of the Impella LP 5.0 pump

We describe the successful use of the Impella LP 5.0 intracardiac microaxial pump (Abiomed, Danvers, MA) in a 13-year-old boy with fulminant biopsy-proven viral myocarditis. The patient, who previously was in refractory cardiogenic shock despite increasing inotropic and vasopressor support, immediately stabilized after Impella LP 5.0 implantation and was successfully bridged to a full recovery. Months later, he remains completely well, with no intracardiac or peripheral vascular sequelae of the procedure. In carefully selected pediatric patients the Impella may be a beneficial form of temporary mechanical circulatory support for fulminant cardiogenic shock.

Myokarditis: Diagnostik und Verlauf

Summary The term “myocarditis” is applied to a variety of inflammatory disorders affecting the myocardium. Because of a wide spectrum of clinical manifestations ranging from asymptomatic to frank circulatory failure little is known about the epidemiological aspects of the disease. Based on the initial presentation four typical clinical syndromes can be distinguished: 10–30% of patients experience acute chest pain indistinguishable from an acute coronary syndrome, 60–70% present with congestive heart failure, in 5–15% arrhythmias might be among the first complaints and 5–10% present with fulminant cardiogenic shock. Thus it is important to rule out other confounding cardiac disorders during the initial diagnostic work-up. In the following review we propose a pragmatic approach to the diagnostic work-up of myocarditis according to the presenting manifestations. The range of the clinical course is also highly variable, notably up to 60% of cases of myocarditis undergo a full recovery, whereas on the other hand progressive pump failure might require a rapid intervention including mechanical circulatory assistance. Interestingly the clinical presentation and symptoms at onset are predictive for the further course and outcome. Further research in basic and clinical science is warranted in the search for an effective treatment and understanding of this challenging disorder.