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Novel Immunotherapy and Mechanical Cardiac Support in Myocarditis: A Case Report

2023; Springer International Publishing; Linguagem: Inglês

10.1007/978-3-031-36398-6_38

2522-5936

Tamishta Hensman, Peter Sherren,

Cardiac Structural Anomalies and Repair

Fulminant myocarditis is a rare and fatal disease, characterised by dysregulated immune response and acute-onset myocardial inflammation leading to cardiogenic shock. We describe the case of GM, a young man with fulminant myocarditis who presented to a peripheral hospital. He was referred to an extra-corporeal membrane oxygenation (ECMO) service for consideration of retrieval after developing recurrent dysrhythmias, including non-sustained ventricular tachycardia. ECMO was used to support organ perfusion whilst steroids and anakinra were given, allowing time for immunosuppression to act to reduce myocardial oedema. His expeditious recovery was demonstrated by rapidly declining inflammatory markers, improvement in his cardiac output and resolution in arrhythmias. In the follow-up phase, he had occasional but persistent arrhythmias. Cardiac MRI was used to differentiate between ongoing oedema and scar tissue, thereby informing ongoing immunosuppression and management of his cardiac rhythm. This case demonstrates the importance of a personalised approach to multi-modal immunotherapy and the utility of ECMO and investigations such as endomyocardial biopsy and cardiac MRI.