Why can flu be so deadly? An unusual case of cardiogenic shock

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Fig. 1
Fig. 2
Fig. 3



C-Reactive protein


Creatine phosphokinase


Continuous renal replacement therapy


Cardiogenic shock


Computed tomography




Fulminant myocarditis


Intra-aortic balloon pump


Intensive care unit


Late gadolinium enhancement


Left ventricular ejection fraction


Pulseless electrical activity


Transesophageal echocardiography


Transthoracic echocardiography


Veno-arterial extracorporeal membrane oxygenation


  1. 1.

    Caforio AL, Pankuweit S, Arbustini E (2013) Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 34:2636–2648

    Article  Google Scholar 

  2. 2.

    Adler Y, Charron P, Imazio M et al (2015) ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC). Eur Heart J 36(42):2921–2964

    Article  Google Scholar 

  3. 3.

    Ammirati E, Cipriani M, Lilliu M et al (2017) Survival and left ventricular function changes in fulminant versus nonfulminant acute myocarditis. Circulation 136:529–545

    Article  Google Scholar 

  4. 4.

    Monsieurs KG, Nolan JP, Bossaert LL, ERC Guidelines 2015 Writing Group et al (2015) European Resuscitation Council guidelines for resuscitation 2015. Resuscitation 95:1–80

    Article  Google Scholar 

  5. 5.

    Spodick DH (2003) Acute cardiac tamponade. N Engl J Med 349:684–690

    Article  Google Scholar 

  6. 6.

    Thiele HE, Ohman M, Desch S, Eitel I, De Waha S (2015) Management of cardiogenic shock. Eur Heart J 36(20):1223–1230

    Article  Google Scholar 

  7. 7.

    Link A, Poss J, Rbahet R et al (2013) Circulating angiopoietins and cardiovascular mortality in cardiogenic shock. Eur Heart J 34(22):1651–1662

    CAS  Article  Google Scholar 

  8. 8.

    Romagnoli S, Franchi F, Ricci Z, Scolletta S, Payen D (2017) The pressure recording analytical method (PRAM): technical concepts and literature review. J Cardiothorac Vasc Anesth 31(4):1460–1470

    Article  Google Scholar 

  9. 9.

    Van Herck JL, Claeys MJ, De Paep R, Van Herck PL, Vrints CJ, Jorens PG (2015) Management of cardiogenic shock complicating acute myocardial infarction. Eur Heart J Acute Cardiovasc Care 4(3):278–297

    Article  Google Scholar 

  10. 10.

    Lorusso R, Centofanti P, Gelsomino S et al (2016) Venoarterial extracorporeal membrane oxygenation for acute fulminant myocarditis in adult patients: a 5-year multi-institutional experience. Ann Thorac Surg 101(3):919–926

    Article  Google Scholar 

  11. 11.

    Mirabel M, Luyt C-E, Leprinc P et al (2011) Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med 39(5):1029–1035

    Article  Google Scholar 

  12. 12.

    Asaumi Y, Yasuda S, Morii I et al (2005) Favourable clinical outcome in patients with cardiogenic shock due to fulminant myocarditis supported by percutaneous extracorporeal membrane oxygenation. Eur Heart J 26:2185–2192

    Article  Google Scholar 

  13. 13.

    Rao P, Khalpey Z, Smith R, Burkhoff Kociol RD (2018) Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail 11(9):e004905

    Article  Google Scholar 

  14. 14.

    Siskin M, Rao S, Rapkiewicz A, Bangalore S, Garshick M (2017) A case of cardiogenic shock secondary to complement-mediated myopericarditis from influenza B infection. Can J Cardiol 33(10):1335

    Article  Google Scholar 

  15. 15.

    Taremi M, Amoroso A, Nace HL, Gilliam BL (2013) Influenza B-induced refractory cardiogenic shock: a case report. BMC Infect Dis 13:452

    Article  Google Scholar 

  16. 16.

    Morimoto S, Kato S, Hiramitsu S et al (2003) Narrowing of the left ventricular cavity associated with transient ventricular wall thickening reduces stroke volume in patients with acute myocarditis. Circ J 67(6):490–494

    Article  Google Scholar 

  17. 17.

    Gräni C, Eichhorn C, Bière L et al (2017) Prognostic value of cardiac magnetic resonance tissue characterization in risk stratifying patients with suspected myocarditis. J Am Coll Cardiol 70(16):1964–1976

    Article  Google Scholar 

  18. 18.

    Naderi ASA, Palmer BF (2006) Rhabdomyolysis and acute renal failure associated with influenza virus type B infection. Am J Med Sci 332(2):88–89

    Article  Google Scholar 

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Correspondence to Alessio Mattesini.

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Ciabatti, M., Vignini, E., Mattesini, A. et al. Why can flu be so deadly? An unusual case of cardiogenic shock. Intern Emerg Med 15, 679–684 (2020). https://doi.org/10.1007/s11739-019-02094-4

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  • Fulminant myocarditis
  • Influenza B
  • Cardiogenic shock
  • Extracorporeal life support