[Fulminant myocarditis causing severe left heart failure and massive thrombus formation following cardiac tamponade: a case report].
A woman aged middle thirties presented with common cold-like symptoms, and was hospitalized due to hypotension and tachycardia. Echocardiography revealed pericardial effusion and preserved left ventricular fractional shortening (28%). Cardiac index, pulmonary capillary wedge and right atrial pressure were 1.8 l/min/m2, 15 and 13 mmHg, respectively. After drainage of pericardial effusion, cardiac index increased to 3.4 l/min/m2. On the fifth hospital day, left ventricular dysfunction developed (fractional shortening: 16%, cardiac index: 1.5 l/min/m2, pulmonary capillary wedge pressure: 18 mmHg, right atrial pressure: 12 mmHg), so percutaneous cardiopulmonary support was introduced. However, the heart failed in asystole and the cavity was occupied by massive thrombus, probably related to heparin-induced thrombocytopenia. This case of fulminant myocarditis passed through various clinical features of heart failure. She died on the 12th hospital day.
Miyamoto
Koji
K
Department of Cardiology, National Cardiovascular Center, Fujishirodai 5 7- 1, Suita, Osaka 565-8565.
Yasuda
Satoshi
S
Noguchi
Teruo
T
Tanimoto
Takashi
T
Kakuchi
Hiroyuki
H
Morii
Isao
I
Kawamura
Atsushi
A
Nakatani
Takeshi
T
Nonogi
Hiroshi
H
Goto
Yoichi
Y
Miyazaki
Shunichi
S
D000328:Adult; D002305:Cardiac Tamponade / Q000209:etiology*; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006333:Heart Failure / Q000209:etiology*; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D009205:Myocarditis / Q000150:complications*; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000150:complications; D013927:Thrombosis / Q000209:etiology*; D018487:Ventricular Dysfunction, Left / Q000209:etiology*
D006493:Heparin