Making change happen: learning from "positive deviancts"
Acute heart failure in meningococcal disease due to myocarditis and sepsis
1.
2. Acute heart failure in meningococcal
disease due to myocarditis and sepsis
CASE REPORT:
Healthy 26 years-old male comes to the emergency department;
History: sore throat, fever, headache, nausea/vomiting and malaise for 2 days;
Physical exam: stable vital signs, no respiratory distress, warm, nuchal rigidity, normal pupils and
no neurologic deficit. Normal cardiac / pulmonary auscultation.
Exams: Labs (high WBC, creatinine, lactate), CXR, Head CT (diffused edema),
LP (CSF w/ low glucose, high protein, diplococci gram negative -> Neisseria meningitidis)
2155
L. Celia Petersen, TR. Reichert, CVE. Drebes, JS. Jardim, SVG. Wanderley, M. Crecenzio, M. Wiehe, LC. Bodanese, JCVC. Guaragna, LC. Danzmann
Hospital São Lucas / PUC-RS, Cardiology, Porto Alegre-RS, Brazil
INTRODUCTION:
Acute heart failure -> syndrome with different aetiologies
(cardiac vs non-cardiac)
-> context of infection: myocarditis vs sepsis.
3. => The patient becomes less responsive with hemodynamic compromise, non-responsive to volume infusion.
=> Intubation - MV, noradrenaline infusion, ceftriaxone, dexametasone.
=> ECG was done and Cardiology (resident) was called at 2:00am:
4. => Point of care (bedside) ultrasound was done:
5. Dx: Acute heart failure – Sepsis
Myocarditis – meningococcal meningoencephalitis (max. troponin 8.660pg/ml)
FOLLOW-UP:
ICU -> pupura-fulminans / atrial fibrillation
Discharged after 20 days -> sinus rhythm, normal EF, no deficit.
DISCUSSION:
The use of point of care ultrasound to define shock aetiology;
Sepsis induced myocardial dysfunction;
Myocarditis = 50% meningoccocal disease;
DDx: ACS (hyperdynamic + coagulation)
Myocardial dysfunction indicates a higher
Incidence of fatal outcome in meningococcal
disease… not in this case!
REFERENCES: 1- Gore I, Saphir O. Myocarditis; a classification of 1402 cases. Am Heart J 1947; 34: 827. 2- Boucek MM, Boerth RC, Artman M, et al. Myocardial dysfunction in children with
acute meningococcemia. J Pediatr 1984; 105:538. 3- Merx MW, Weber C. Sepsis and the heart. Circ 2007; 116: 793-802. 4- Leslie T, Cooper Jr. Myocarditis Review. N Engl J Med
2009;360:1526-38.
