Influenza A(H1N1) infection and severe cardiac dysfunction in adults: A case series.
BACKGROUND
While viral myocarditis and heart failure are recognized and feared complications of seasonal influenza A infection, only limited information is available for 2009 influenza A(H1N1)-induced heart failure.


RESULTS
This case series summarizes the disease course of four patients with 2009 influenza A(H1N1) infection who were treated at our institution from November 2009 until September 2010. All patients presented with severe cardiac dysfunction (acute heart failure, cardiogenic shock or cardiac arrest due to ventricular fibrillation) as the leading symptom of influenza A(H1N1) infection. Two patients most likely had pre-existent cardiac pathologies, and three required catecholamine therapy to maintain hemodynamic function. Except for one patient who died before influenza A(H1N1) infection had been diagnosed, all patients received antiviral therapy with oseltamivir and supportive critical care. Acute respiratory distress syndrome due to influenza A(H1N1) infection developed in one patient. Heart function normalized in two of the three surviving patients but remained impaired in the other one at hospital discharge.


CONCLUSIONS
Influenza A(H1N1) infection may be associated with severe cardiac dysfunction which can even be the leading clinical symptom at presentation. During an influenza pandemic, a thorough history may reveal flu-like symptoms and should indicate testing for H1N1 infection also in critically ill patients with acute heart failure.
Department of Intensive Care Medicine, Inselspital Bern, Bern, Switzerland.
Jan A
JA
Wiegand
Christian
C
Torgersen
Stefan
S
Bloechlinger
Jukka
J
Takala
Martin W
MW
Dünser
D000328:Adult; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology*; D055815:Young Adult
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