Fulminant Myocarditis Due to H1N1 Influenza

Abstract

W e report 2 cases of fulminant myocarditis caused by the H1N1 strain of influenza. As the incidence of H1N1 influenza infection continues to rise, physicians should be aware of this rare and potentially fatal complication because early diagnosis and aggressive supportive measures are imperative. Case 1A 52-year-old woman presented with a 3-day history of chest pain, dyspnea, diffuse myalgias, and fever. The ECG demonstrated low voltage with diffuse ST segment elevation ( Figure 1). The troponin I was 5 ng/mL (0 to 0.75 ng/mL), and B-type natriuretic peptide was 1629 pg/mL (0 to 100 pg/mL). The patient was transferred to our facility for urgent left heart catheterization. On presentation, her blood pressure was 87/50 mm Hg. Coronary angiography demonstrated normal coronary arteries. Dopamine was started for blood pressure support. The patient was treated with oseltamivir 150 mg twice a day and IV ceftriaxone for suspected viral and/or bacterial myocarditis and pneumonitis. A transthoracic echocardiogram demonstrated global left ventricular systolic dysfunction with an ejection fraction of 29% and a trivial pericardial effusion. Blood cultures and rapid influenza A and B antigen tests were negative. On day 3 of hospitalization, the patient had worsening respiratory distress requiring mechanical ventilation. A repeat transthoracic echocardiogram demonstrated an ejection fraction of 10%. A milrinone infusion was started at that time. Right heart catheterization demonstrated a pulmonary artery pressure of 31/20 mm Hg and cardiac index of 1.33 L/(min ⅐ m 2 ) by the Fick method. An

Fulminant myocarditis in an adult with 2009 pandemic influenza A (H1N1 influenza) infection

“…The purpose for using ECMO in this particular case was circulatory/hemodynamic support. Al-Amoodi et al 7 and Bratincsak et al 8 have reported limited experiences in the use of ECMO in H1N1 infection with fulminant myocarditis. In our case, we implemented ECMO at a very early stage, resulting in a favorable outcome.…”

Immune Mechanisms in Cardiovascular Diseases Associated With Viral Infection

“…Studies have shown elevation of cardiac injury markers and acute phase proteins are indicators of cardiovascular events associated with influenza virus infection (38,39). Myocardial injury can be determined by serum biomarkers including the MB form of creatine kinase (CK-MB), lactate dehydrogenase (LDH), and troponin (TnT) (40,41).…”

Transient cardiac injury during H7N9 infection

“…Acute myocarditis associated with other avian flu, H1N1 in particular, has been widely reported and is potentially lethal in form as fulminant myocarditis . However, a national survey in Japan on myocarditis‐associated 2009 H1N1 pandemic only revealed 15 myocarditis cases in a total of 24203 patients .…”

“…1. The number of patients in each group is as follows: Group I (0), Group II (21), Group III (15) and Group IV (4). All patients have been tested H7N9 negative as on 9 May 2013, among whom eighteen have been discharged from hospital, five transferred to general ward and five died.…”