Intra-aortic balloon pump in toxic myocarditis due to aluminum phosphide poisoning.
BACKGROUND
Aluminum phosphide (ALP) is a pesticide that is highly toxic. It is a mitochondrial toxin that causes death by cardiac and metabolic toxicity. The most ominous effect is cardiac toxicity, which may range from minor electrocardiographic abnormalities to severe depression of cardiac contractility secondary to toxic myocarditis. There is no documented report of the use of Intra-aortic Balloon Pump (IABP) for toxic myocarditis from ALP poisoning, although it has been used effectively for toxic myocarditis due to other toxins.


METHODS
We are reporting a young female who presented with ALP poisoning, in cardiogenic shock due to myocarditis. We used an IABP for cardio-circulatory support until the effects of ALP resolved. She is the only reported survivor of ALP poisoning, presenting with cardiogenic shock.


CONCLUSIONS
Several reports describe the use of IABP for cardiogenic shock due to toxic myocarditis. There is no report in the medical literature using IABP for cardiogenic shock caused by ALP toxin-induced myocarditis. Our patient presented with cardiocirculatory shock, necessitating the use of inotropes and mechanical ventilation. As she did not improve despite ventilation and maximal doses of inotropes, IABP was used for cardio-circulatory support until the effects of ALP resolved.
Siddaiah
Latha
L
Department of Cardiology, St. John's Medical College Hospital, Bangalore, India. dr.latha_ms@yahoo.co.in
Adhyapak
Srilakshmi
S
Jaydev
Santosh
S
Shetty
Gurappa
G
Varghese
Kiron
K
Patil
Chandrakanth
C
Iyengar
Shamanna
S
D017607:Aluminum Compounds / Q000506:poisoning*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005751:Gastric Lavage; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D009205:Myocarditis / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy*; D009638:Norepinephrine / Q000627:therapeutic use; D010575:Pesticides / Q000506:poisoning*; D010720:Phosphines / Q000506:poisoning*; D012770:Shock, Cardiogenic / Q000139:chemically induced / Q000503:physiopathology / Q000628:therapy*; D013406:Suicide, Attempted; D016896:Treatment Outcome; D055815:Young Adult
D017607:Aluminum Compounds; D002316:Cardiotonic Agents; D010575:Pesticides; D010720:Phosphines; D004280:Dobutamine; C001864:aluminum phosphide; D009638:Norepinephrine