Acute Heart Failure Without Prior History of Myocardial Dysfunction
Heart failure is an abnormality of cardiac function that leads to failure in delivering adequate levels of oxygen to supply tissue metabolic needs, with increasing incidence rates in the last years. We present here a case of a 62-year-old female patient admitted in the emergency room with sudden onset and progressive dyspnea for about 1 h before admission. Comorbidities referred by the patient included rheumatoid arthritis and a recent upper airways infection. Clinical examination findings evidenced tachycardia, tachypnea, and hypotension (96 × 60 mmHg); jugular venous distension; plethora in the face, neck, and upper chest; and distant heart sounds upon auscultation. An electrocardiogram was realized and revealed atrial fibrillation. Transthoracic echocardiography showed severe left ventricular dysfunction and mild to moderate pericardial effusion with right ventricular collapse and ejection fraction of 15%. Heart failure may be associated with myocarditis, an inflammatory immune response of the host, resulting in dilated cardiomyopathy and acute heart failure. Considering the persistent cardiogenic shock and to prevent multiple organ failure, a circulatory assistance device was installed – venoarterial ECMO. Recurrent complications followed, leading to substitution of ECMO to CentriMag. There was complete recovery of the biventricular function after this measure, and the device was explanted shortly afterward.
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