scholarly journals Fulminant myocarditis: use of echocardiography from diagnosis to extracorporeal membrane oxygenation

2020 ◽  
Vol 7 (3) ◽  
pp. K21-K26
Author(s):  
Na Hyun Park ◽  
Hazem Lashin ◽  
Rosalba Spiritoso
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Early Recognition ◽  
Heart Function ◽  
Thrombus Formation ◽  
Fulminant Myocarditis ◽  
High Dose ◽  
List Type ◽  
Membrane Oxygenation ◽  
Threatening Condition ◽  
Life Threatening

Summary Fulminant myocarditis can present with life-threatening arrhythmias and cardiogenic shock due to ventricular failure. The diagnosis of myocarditis usually requires histological and immunological information, as its aetiology may be infectious (viral or non-viral), autoimmune or drug related. The treatment of fulminant myocarditis depends on the underlying cause but usually includes high dose systemic steroids as well as physiological support. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support patients as a bridge to recovery by supporting biventricular function and decompressing the heart. V-A ECMO carries risks and complications of its own such as thrombus formation or bleeding. Different diagnostic modalities, such as transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE), are central to the monitoring of progression of disease and recovery of heart function. This case highlights the importance of early recognition and early support with V-A ECMO in fulminant myocarditis, as well as the role of repeated echocardiography when weaning from physiological support. Learning points: Myocarditis is a life-threatening condition and early recognition of cardiac failure can be assisted with a bedside echocardiogram. Extracorporeal membrane oxygenation is used as a bridging method of treatment for patients with cardiogenic failure in myocarditis but has its own risks related to anticoagulation and the procedure itself. There are currently no standardised guidelines of when to wean a patient off extracorporeal membrane oxygenation, but echocardiography acts as an important guide to detect complications as well as cardiac recovery.

scholarly journals Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Anamaria Milas ◽  
Aditya Shah ◽  
Neesha Anand ◽  
Meghan Saunders-Kurban ◽  
Samir Patel
Keyword(s):  
Respiratory Syncytial Virus ◽  
Extracorporeal Membrane Oxygenation ◽  
Fulminant Myocarditis ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
Va Ecmo

Severe fulminant myocarditis causing cardiogenic shock can be a rapidly progressing, life threatening condition. Respiratory syncytial virus (RSV) is a very rare infectious culprit infrequently described in medical literature as a cause of myocarditis, particularly in adults. We present a case of acute fulminant myocarditis in a patient with PCR positive RSV infection requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO).

scholarly journals Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients

2021 ◽  
Author(s):  
Surat Tongyoo ◽  
Suneerat Kongsayreepong
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Ecmo Support ◽  
Janus Kinase ◽  
Systemic Steroid ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
Rescue Treatment ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Individual

During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.

Severe case of Lemierre syndrome with multiple neurological and ophthalmological sequelae

2021 ◽  
Vol 14 (8) ◽  
pp. e244669
Author(s):  
Alice Liu ◽  
Jemma Taylor ◽  
Monica Slavin ◽  
Steven Tong
Keyword(s):  
Early Recognition ◽  
Surgical Excision ◽  
Severe Case ◽  
Intracranial Extension ◽  
High Dose ◽  
Lemierre Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Right ◽  
Discharge From Hospital

A 56-year-old man was admitted to intensive care with septic shock, multiple facial abscesses and thrombophlebitis of the right internal jugular vein with extensive intracranial extension. A diagnosis of Lemierre syndrome due to Streptococcus anginosus was made and treatment initiated with high-dose ceftriaxone and metronidazole, along with surgical debridement. His admission was complicated by raised intraocular pressures and visual loss requiring bilateral canthotomies. Despite therapeutic anticoagulation with enoxaparin, he also developed an ischaemic basal ganglia infarct. After a prolonged and complex hospital stay, the patient was later readmitted with an intracerebral abscess requiring surgical excision and a second course of antibiotics. This case highlights the value of early recognition of this rare but potentially life-threatening condition, considerations around anticoagulation and antibiotic decisions, and the importance of close multidisciplinary follow-up even after discharge from hospital.

The First Case of Multisystem Inflammatory Syndrome in Children Successfully Treated with Combined Therapies Including Extracorporeal Membrane Oxygenation and Plasmapheresis

2021 ◽  
Author(s):  
Capan Konca ◽  
Ayse B. Anil ◽  
Onur Isik ◽  
Emine P. Kulluoglu ◽  
Doga Luleyap ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Severe Disease ◽  
Anticoagulation Therapy ◽  
Definitive Treatment ◽  
Membrane Oxygenation ◽  
First Case ◽  
Threatening Condition ◽  
Child Patient ◽  
Life Threatening ◽  
Inflammatory Syndrome

AbstractMultisystem inflammatory syndrome in children (MIS-C) is a severe disease that can lead to death. There is no definitive treatment for MIS-C yet. It has been reported that intravenous immunoglobulin, intravenous methylprednisolone, fluid supplements, antibiotics, inotropics, extracorporeal membrane oxygenation (ECMO), plasmapheresis, biological therapy, and anticoagulation therapy can be used for treatment. In this article, we presented an 8-year-old girl child patient who survived due to timely administered ECMO and combined therapies including plasmapheresis without any sequela despite her life-threatening condition due to MIS-C.

scholarly journals Beriberi Induced Cardiomyopathy Requiring Salvage Venoarterial Extracorporeal Membrane Oxygenation

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Aditya Shah ◽  
Samir Patel ◽  
Sorabh Kothari ◽  
Jennifer Denk
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Early Recognition ◽  
Heart Function ◽  
Vitamin B1 ◽  
Rare Condition ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Malnourished Patient ◽  
Vitamin B1 Deficiency ◽  
Va Ecmo

Beriberi refers to a constellation of symptoms caused primarily by thiamine (vitamin B1) deficiency. An acute and fulminant presentation of this rare condition has been described in the literature as “Shoshin” beriberi which is characterized by catastrophic cardiovascular collapse. Early recognition and treatment lead to dramatic improvements of symptoms. We present a case of thiamine deficiency-induced acute heart failure in a malnourished patient leading to cardiac arrest necessitating VA-ECMO (venoarterial extracorporeal membrane oxygenation) with improvement in heart function secondary to thiamine administration.

scholarly journals Successful management of warfarin-exacerbated diffuse alveolar hemorrhage using an extracorporeal membrane oxygenation

2013 ◽  
Vol 8 ◽  
Author(s):  
Jong Hoo Lee ◽  
Su Wan Kim
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Warfarin Therapy ◽  
Ventilatory Support ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Vein Thrombosis ◽  
Membrane Oxygenation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Chest X Ray

Although diffuse alveolar hemorrhage complicating warfarin therapy is rare, it generally has a worsening clinical course and can be a life threatening condition. A 56-year-old male who had undergone a pulmonary lobectomy for lung cancer 2 years before had received warfarin for about 5 months due to pulmonary vein thrombosis. The patient presented with severe dyspnea and had prolonged anticoagulation values. Chest X-ray and computed tomography revealed diffuse pulmonary consolidations, and bronchoalveolar lavage demonstrated diffuse alveolar hemorrhage. The reversal of anticoagulation was initiated, and extracorporeal membrane oxygenation was performed for refractory respiratory failure that did not improve despite maximal mechanical ventilatory support. The diffuse alveolar infiltrations resolved after 5 days, and we successfully weaned off both extracorporeal membrane oxygenation and mechanical ventilation. Herein we report the detailed course of a case that was successfully treated with extracorporeal membrane oxygenation as a bridge-to-recovery for warfarin- exacerbated diffuse alveolar hemorrhage.

scholarly journals The Saviour of a Pregnant Woman With Fulminant Myocarditis ——Extracorporeal Membrane Oxygenation: A Case Report

2021 ◽  
Author(s):  
Yanan Lin ◽  
Bin Wang ◽  
Xu Lin ◽  
Fuguo Ma ◽  
Zhaozhuo Niu ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Extracorporeal Membrane Oxygenation ◽  
Pregnant Women ◽  
Heart Function ◽  
Antiviral Treatment ◽  
Fulminant Myocarditis ◽  
Reactive Protein ◽  
Membrane Oxygenation ◽  
Whole Process ◽  
Ecmo Treatment

Abstract INTRODUCTION: There are no reports regarding a pregnant woman with fulminant myocarditis underwent Extracorporeal Membrane Oxygenation (ECMO). Hence, we report a case of successful ECMO treatment of fulminant myocarditis puerpera. CASE PRESENTATION: A 32-year-old puerpera was admitted to our hospital with menopause for 7 months, fetal movement for 3 months and fever for 1 day. After admission, the patient's body temperature increased repeatedly, heart rate increased, and the whole process C-reactive protein increased rapidly. Considered a diagnosis of fulminant myocarditis. After antiviral and cardioprotective treatment, the heart function progressively worsened. Pregnancy was terminated, the newborn was intubated in the neonatal room for rescue after surgery, and ECMO treatment was given after the puerpera was transferred to the intensive care unit. Finally, the patient and the baby have been safely discharged from hospital. DISCUSSION: ECMO can provide cardiac and respiratory support. Fulminant myocarditis is common in children, adolescents and particularly pregnant women who had the highest mortality rate. In the pregnant woman with fulminant myocarditis described in this report, antiviral treatment only transiently improved heart function and then heart function progressively worsened. After receiving ECMO therapy, the patient's cardiac function has improved markedly. The patient was then successfully weaned from ECMO. To our knowledge, this is the first report of pregnant woman in whom ECMO was part of the treatment for fulminant myocarditis. CONCLUSION: We report a case of successful ECMO treatment of fulminant myocarditis puerpera. ECMO can be the treatment of choice for pregnant women with fulminant myocarditis.

scholarly journals Extracorporeal Membrane Oxygenation for Diffuse Alveolar Hemorrhage Caused by Idiopathic Pulmonary Hemosiderosis: A Case Report and a Review of the Literature

2019 ◽  
Vol 08 (03) ◽  
pp. 181-186 ◽  
Author(s):  
Shotaro Matsumoto ◽  
Satoshi Nakagawa
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Rescue Therapy ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Membrane Oxygenation ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Anticoagulation ◽  
Idiopathic Pulmonary Hemosiderosis

AbstractDiffuse alveolar hemorrhage (DAH) is a life-threatening condition presenting with hemoptysis, anemia, and diffuse radiographic pulmonary infiltrates; it causes acute respiratory failure. Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of DAH occurring predominantly in children. Bleeding is often considered to be a contraindication for extracorporeal membrane oxygenation (ECMO) due to systemic anticoagulation. We present an 8-year-old girl with DAH caused by IPH. Unfractionated heparin was administered to maintain an activated clotting time of 150 to 180 seconds. The DAH resolved with immunosuppressive therapy, and the patient survived to decannulation. ECMO may be applied as a rescue therapy for DAH even with systemic anticoagulation.

scholarly journals Rapid Extracorporeal Membrane Oxygenation Overcomes Fulminant Myocarditis Induced by 5‑Fluorouracil

2016 ◽  
Vol 43 (2) ◽  
pp. 178-182 ◽  
Author(s):  
Alok R. Amraotkar ◽  
Ajay Pachika ◽  
Kendra J. Grubb ◽  
Andrew P. DeFilippis
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Systolic Function ◽  
Stable Condition ◽  
Tissue Perfusion ◽  
Fulminant Myocarditis ◽  
Anal Squamous Cell Carcinoma ◽  
Membrane Oxygenation ◽  
Life Threatening Illness ◽  
Life Threatening

Fulminant myocarditis is a rare but potentially life-threatening illness caused by 5-fluorouracil cardiotoxicity. Data supporting the use of extracorporeal membrane oxygenation for the treatment of fulminant myocarditis are limited. A 49-year-old, previously healthy white man, recently diagnosed with anal squamous cell carcinoma, developed severe chest pain hours after completing his first 96-hour intravenous 5-fluorouracil treatment. Over a period of 3 days from onset of symptoms, the patient developed cardiogenic shock secondary to fulminant myocarditis induced by 5-fluorouracil cardiotoxicity. This required emergency initiation of extracorporeal membrane oxygenation. The patient's systolic function recovered by day 5, and on the 17th day he was discharged in hemodynamically stable condition, without symptoms of heart failure. This case shows the importance of prompt recognition of cardiogenic shock secondary to 5-fluorouracil–induced myocarditis and how the immediate initiation of extracorporeal membrane oxygenation can restore adequate tissue perfusion, leading to myocardial recovery and ultimately the survival of the patient.

scholarly journals Respiratory Distress Syndrome Associated with Erythrodermic Psoriasis

2021 ◽  
pp. 83-88
Author(s):  
Lamya Noure ◽  
Kirley Küçük ◽  
Sylvain Raoul Simeni Njonnou ◽  
Véronique Del Marmol ◽  
Jonathan M. White ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Early Recognition ◽  
Past History ◽  
High Dose ◽  
Threatening Condition ◽  
Erythrodermic Psoriasis ◽  
Life Threatening ◽  
Dose Corticosteroid

Erythrodermic psoriasis is an uncommon and severe variant of psoriasis which may be associated with rare and severe complications such as acute respiratory distress syndrome. Early recognition of this life-threatening condition can allow prompt appropriate treatment. We report the case of a 69-year-old man with a long history of psoriasis who developed acute respiratory distress during a disease flare-up. There was no relevant past history (except for mild emphysema), known allergy, or recent treatment. Chest X-ray revealed new bilateral infiltrates, confirmed at chest computed tomography scan. Repeated cultures on aspirate of the bronchoalveolar lavage remained negative for viruses, bacteria, and parasites. Cardiac ultrasound was normal and high-dose corticosteroid therapy was initiated. Within a few days his clinical and radiological status improved significantly.

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