76 y/o with acute decompensated HF 2/2 Fulminant Myocarditis
**Normal coronaries do NOT r/o MI - can have embolic event that lyses**
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.
Ex: Intermacs 1: Critical cardiogenic shock with organ failure - rather than use escalating devices just choose a device that you think can support the patient (always have an idea if this is a bridge or destination therapy, or if recovery is possible).
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