Pearls from Dr. Reshad Garan

76 y/o with acute decompensated HF 2/2 Fulminant Myocarditis

2016-08-09

    1. **Normal coronaries do NOT r/o MI - can have embolic event that lyses**
    2. Pt. with Enterovirus and HF symptoms - think about Myocarditi

    Posted 08/09/16 10:46:45 AM by Adam Faye

  • Acute Fulminant Myocarditis - typically have normal ventricular size - large dilated ventricles more characteristic of a chronic picture.
    TTE with Definity - Ultrasound contrast agent that can opacify the LV and improve delineation of the LV endocardial border (see thrombus)
    Myocarditis with electrical abnormalities- think about Giant Cell Myocarditis

    Posted 08/09/16 10:47:58 AM by Adam Faye

  • IABP (Intra-aortic balloon pump) - 1/2 - 1L augmentation (need pulsatility) --> good for decompensated HF in chronic patients (in chronic HF patients- typically compensated - so small augmentation will help; whereas those with acute HF need more augmentation of flow).
    When patient on multiple inotropes start to think of circulatory support.

    Posted 08/09/16 10:57:57 AM by Adam Faye

  • Intermacs Profile Clinical picture of a patient going for a VAD.

    Posted 08/09/16 11:00:08 AM by Adam Faye

  • VA ECMO - Increases afterload for a failing ventricle so can worsen recovery -> can also lead to atrial valve closure/thromus formation

    Posted 08/09/16 03:00:00 PM by Adam Faye

  • For further reading...

    LVAD
    Myocarditis

    Posted 08/09/16 03:16:29 PM by Adam Faye


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