Ivabradine As An Adjuvant Treatment Of Cardiogenic Shock In A Young Woman With Acute Myocarditis: A Case Report

Tóm tắt

Background

Myocarditis is an inflammatory disease involving the myocardium that can manifest as a fatal cardiogenic shock. Inotropes used in cardiogenic shock can induce tachycardia and subsequently increased myocardial oxygen consumption and arrhythmogenic risk. Ivabradine is thought to control tachycardia and improve hemodynamic.

Methods

A 24-year-old woman came with a chief complaint of worsening shortness of breath in the last 24 hours. In the preceding days, she had intermittent fever accompanied with severe headache, nausea and vomiting. She had hypotension and tachycardia at admission. Blood tests showed elevated cardiac enzymes, NT-pro BNP and lactate levels. Echocardiography showed reduced left ventricular systolic function, reduced right ventricular contractility, global ventricular wall hypokinesis and low cardiac output state.

Results

The patient was diagnosed as cardiogenic shock due to acute myocarditis. Dobutamine was given to augment cardiac contractility with a subsequent tachycardia effect. We then used ivabradine to reduce the heart rate and found significant hemodynamic improvement. She was discharged home with good clinical condition and improved echocardiography parameters.

Conclusion

Use of ivabradine as an adjuvant therapy of cardiogenic shock may be beneficial in acute myocarditis settings.