Background Fulminant perimyocarditis is an uncommon cause of cardiogenic shock and refractory cardiac arrest. We describe Influenza A (H1N1)–associated perimyocarditis managed with a stepwise extracorporeal resuscitation strategy. Case A 54‐year‐old woman presented with chest pain, hypoxemia, and cardiogenic shock. Electrocardiography (ECG) showed diffuse ST‐segment elevation. Echocardiography revealed severe biventricular dysfunction and a fibrinous pericardial effusion and coronary angiography excluded obstructive disease. Despite vasoactive support and mechanical circulatory support with microaxial flow pump Impella CP (flow 2.7 L/min.), she deteriorated to Society for Cardiovascular Angiography and Interventions (SCAI) Stage E with pulseless electrical activity (PEA). During automated chest compressions, mechanical circulatory support with femoral Impella CP was rapidly escalated to venoarterial extracorporeal membrane oxygenation (VA‐ECMO). Respiratory polymerase chain reaction (PCR) was positive for Influenza A (H1N1) virus. Antiviral therapy, heparin anticoagulation, ventilation, and organ support were instituted. Hemodynamics stabilized, lactate cleared, and neurological examination after decannulation was intact. Progressive myocardial recovery permitted VA‐ECMO explant on Day 3 and Impella CP removal 24 h thereafter. She was extubated on Day 6 and discharged from intensive care unit (ICU) on Day 10. Cardiac magnetic resonance (CMR) imaging confirmed myocarditis; echocardiography at follow‐up showed preserved biventricular function. Conclusion In fulminant perimyocarditis with refractory arrest, rapid activation of an extracorporeal cardiopulmonary resuscitation (ECPR) pathway with early VA‐ECMO—combined with ventricular unloading—can bridge to myocardial recovery and favorable neurological outcome. Regional systems enabling safe transfer under continuous cardiopulmonary resuscitation (CPR) are critical.
Introduction Systemic light‐chain (AL) amyloidosis is a complex disorder characterized by extracellular fibril deposition, leading to severe multisystem dysfunction. When sepsis superimposes on preexisting organ impairment, early clinical recognition becomes particularly challenging yet critical. Methods We present a case of a 60‐year‐old female who presented with generalized edema, dyspnea, and cardiac/renal involvement, subsequently diagnosed with AL amyloidosis based on laboratory, imaging, bone marrow biopsy, and Congo red staining findings. Results Following chemotherapy with bortezomib and cyclophosphamide, the patient experienced transient cardiac arrest, received an implantable cardioverter defibrillator, and subsequently developed massive ascites. Upon developing Pseudomonas guariconensis bacteremia, she progressed to septic shock requiring intensive care unit admission, mechanical ventilation, vasopressor support, and targeted antimicrobial therapy. Through aggressive supportive care and source control, hemodynamic stabilization was achieved, allowing successful extubation and transfer to the general ward. Conclusions Superimposed sepsis on severe, multi‐organ amyloidosis significantly complicates diagnosis and management. High clinical vigilance, early infection recognition, and prompt targeted therapy are essential to prevent fatal outcomes in patients with preexisting chronic organ dysfunctions.
We present the case of a 62-year-old nondiabetic woman receiving dapagliflozin for dilated cardiomyopathy presenting to the emergency department with severe hypoxemic respiratory failure because of suspected cardiogenic pulmonary edema. Despite treatment, she remained symptomatic and required intubation and intensive care admission. After intubation, high-anion-gap metabolic acidosis was unmasked. After exclusion of other common causes, SGLT2 inhibitor–associated ketoacidosis due to dapagliflozin was suspected. Marked ketonuria confirmed the diagnosis despite the absence of hyperglycemia. Dapagliflozin was discontinued, and intravenous insulin, glucose infusion, and early enteral nutrition were initiated. Metabolic acidosis resolved completely within 24 h. The patient was successfully extubated and discharged from the intensive care unit 48 h later. SGLT2 inhibitor–associated ketoacidosis should be considered in patients receiving sodium-glucose cotransporter-2 inhibitors who develop otherwise unexplained high-anion-gap metabolic acidosis, irrespective of diabetic status or blood glucose concentration. Fasting and acute illness are relevant precipitating factors; prompt drug withdrawal, carbohydrate administration, insulin therapy, and nutritional support can lead to rapid resolution.
Invasive Group A Streptococcus (iGAS) infection is a disease state with increasing incidence internationally. This case report outlines a patient with severe septic shock from Group A beta-haemolyticStreptococcus within a provincial intensive care unit (ICU) in New Zealand. Consequently, this case has prompted discussion on the local change in epidemiology for Group A beta-haemolytic Streptococcus (GAS) and a review of the evidence of recognised interventions for iGAS and Streptococcal toxic shock syndrome (STSS).
Heat stroke is a life-threatening condition characterized by elevated core body temperature (≥ 40°C) and central nervous system (CNS) dysfunction, resulting from body's inability to adequately dissipate heat. It can lead to multiorgan failure, including the cardiovascular system. Takotsubo cardiomyopathy (TCM), also known as stress-induced cardiomyopathy, is an acute syndrome of transient global or regional ventricular dysfunction, most commonly apical ballooning, mimicking acute coronary syndrome, typically occurring after severe physical or emotional stress. Although individually well-described, the combination of severe heat stroke as a trigger for TCM is rare. This case report describes a female patient with severe heat stroke who developed TCM and, due to persistent hyperthermia unresponsive to conventional cooling methods, was successfully cooled using prolonged intermittent hemodiafiltration. It also highlights the importance of timely recognition of atypical complications such as TCM in patients with cardiovascular instability and demonstrates the potential role of hemodialysis as an effective cooling method in cases of refractory hyperthermia.
