BROADCASTS.com

CardioNerds cofounder Dr. Dan Ambinder joins Dr. Angie Molina, Dr. Cullen Soares, and Dr. Andrew Lutz from the University of Maryland Medical Center for some beers and history by Fort McHenry. They discuss a case of disseminated\xa0haemophilus influenzapresumed fulminant bacterial myocarditis with mixed septic/cardiogenic shock. Expert commentary is provided by Dr. Stanley Liu (Assistant Professor, Division of Cardiovascular Medicine, University of Maryland School of Medicine). Episode audio was edited by Dr. Chelsea Amo-Tweneboah.\n\n\n\nA woman in her twenties with a history of intravenous drug use presented with acute onset fevers and sore throat, subsequently developed respiratory distress and cardiac arrest, and was noted to have epiglottic edema on intubation. She developed shock and multiorgan failure. ECG showed diffuse ST elevations, TTE revealed biventricular dysfunction, and pleural fluid culture grew Haemophilus influenza. Right heart catheterization showed evidence of cardiogenic shock. She improved with supportive care and antibiotics.\n\n\n\n\n\n\n\nUS Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here.\n\n\n\n\n\n\n\n\n\nCardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\nPearls - Sore Throat, Fever, and Myocarditis - It\u2019s not always COVID-19\n\n\n\n\nThe post-cardiac arrest\xa0ECG provides helpful information for diagnosing the underlying etiology.\u200b\n\n\n\nBe aware of diagnostic biases - availability and anchoring biases are particularly common during respiratory viral (such as COVID-19, RSV) surges.\n\n\n\nConsider a broad differential diagnosis in evaluating\xa0myocarditis, including non-viral etiologies.\n\n\n\nRight heart catheterization provides crucial information for diagnosis and management of undifferentiated shock\u200b.\n\n\n\nWhen assessing the need for mechanical circulatory support, consider the current hemodynamics, type of support needed, and risks associated with each type.\n\n\n\n\nShow Notes - Sore Throat, Fever, and Myocarditis - It\u2019s not always COVID-19\n\n\n\n\nECG findings consistent with pericarditis include diffuse concave-up ST elevations and downsloping T-P segment (Spodick\u2019s sign) as well as PR depression (lead II), and PR elevation (lead aVR). In contrast, regional ST elevations with \u201creciprocal\u201d ST depressions and/or Q-waves should raise concern for myocardial ischemia as the etiology.\n\n\n\nBiventricular dysfunction and elevated troponin are commonly seen post-cardiac arrest and may be secondary findings. However, an elevation in troponin that is out of proportion to expected demand ischemia, ECG changes (pericarditis, ischemic ST elevations), and cardiogenic shock suggest a primary cardiac etiology for cardiac arrest.\n\n\n\nThe differential diagnosis of infectious myopericarditis includes, most commonly, viral infection (respiratory viruses) and, more rarely, bacterial, fungal, or parasitic. Noninfectious myopericarditis may be autoimmune (such as lupus, sarcoidosis, checkpoint inhibitors), toxin-induced (alcohol, cocaine), and medication-induced (anthracyclines and others).\n\n\n\nRight heart catheterization can help diagnose the etiology of undifferentiated shock, including distinguishing between septic and cardiogenic shock, by providing right and left-sided filling pressures, pulmonary and systemic vascular resistance, and cardiac output.\n\n\n\nMechanical circulatory support (MCS) is indicated for patients in cardiogenic shock with worsening end-organ perfusion despite inotropic and pressor support. MCS includes intra-aortic balloon pump, percutaneous VAD, TandemHeart, and VA-ECMO. The decision to use specific types of MCS should be individualized to each patient with their comorbidities and hemodynamic profile. Shock teams are vital to guide decision-making.\n\n\n\n\n\n\n\n\n\n\nReferences \n\n\n\n\nWitting MD, Hu KM, Westreich AA, Tewelde S, Farzad A,