Refractory Cardiogenic Shock Induced by Influenza Type B

Introduction Good health education among patients and health professionals with updated preventive vaccination for myocarditis can improve the survival outcome. In addition to this, Knowing the indications of ECMO in case of resucitataion with a good installation in an appropriate timing will prevent multiple organ failure and lead to rapid recovery with short duration use of Extracorporeal Life Support, this case report is rare there is just a few cases reported in 2013 and we do an improvement in our management. Case presentation A 49 year-old-woman without known heart disease was referred to our university hospital emergency department after 3 days of Influenza symptoms. At her arrival, rapid-onset cardiogenic shock with normal left ventricular size, diffuse left ventricular hypokinesia, and an ejection fraction of 5 % are confirmed by Trans-thoracic echocardiography. Coronary angiography was normal. Echocardiography shows no valves abnormality. However, the patient gets in cardiorespiratory arrest. So, an external cardiac massage was performed then an Extracorporeal Life Support was required. A nasal swap at the admission was positive for influenza B virus. All other respiratory, blood and urine cultures were negative. On day 8, a repeated Trans-thoracic echocardiography demonstrated significant recovery of left ventricular function with ejection fraction of 20 %. Then, full recovery on day 12 with ejection fraction of 50 %. Conclusions Influenza type B infection can cause a fulminant cardiomyopathy without preexisting cardiac disease which can leads to refractory cardiogenic shock. ECMO is a suitable choice for fulminant myocarditis. List of abbreviations Fulminant Myocarditis (FM), ElectroCardioGram (ECG), Extracorporeal Life Support (ECLS), Emergency Room (ER), Blood Pressure (BP), IntraVenous (IV), Intensive Care Unit (ICU), Arterial Blood Gas (ABG), Trans-Esophageal Echocardiography (TEE), Left Ventricular (LV), Left Ventricular Ejection Fraction (LVEF), Cardiac Index (CI), White Blood Cell (WBC), Sodium (Na), Potassium (K), Chloride (Cl), C-Reactive Protein (CRP), Creatinine (Cr), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Trans-Thoracic Echocardiography (TTE), Capillary Wedge Pressure (PCW), Transapical Left Ventricle Vent (TLVV), Broncho alveolar lavage (BAL), Ejection Fraction (EF), World Health Organization (WHO), Cardio-Pulmonary Resuscitation (CPR), Ventricular Assisted Device (VAD), Bi- Ventricular Assisted Device (BiVAD).