Objective: Treatment of viral fulminant myocarditis relies on life support measures. Based on studies pointing to a role for the proinflammatory cytokine interleukin-1 in myocardial inflammation and contractile dysfunction, we treated a patient with fulminant viral myocarditis with the interleukin-1 receptor blocking agent anakinra. We report the response and discuss the biologic rationale of this novel treatment approach. Design: Case report. Setting: ICU. Patient: A 36-year-old woman who was hospitalized for fulminant myocarditis with biventricular failure and cardiogenic shock, acutely manifested with hypotension and dyspnea. Interventions: Following the progressive, life-threatening collapse of the cardiac function in spite of treatment with venous-arterial extracorporeal membrane oxygenation and mechanical circulatory support with a left ventricular assist device, treatment with the interleukin-1 receptor blocking agent anakinra 100 mg/d was started. Measurements and Main Results: The severe depression of cardiac function responded promptly to interleukin-1 inhibition. Within 4 days of treatment initiation, progressive clinical improvement allowed weaning from extracorporeal membrane oxygenation and removal of the percutaneous left ventricular assist device. The patient was discharged home and remains in excellent health at 12 months. Conclusions: Clinical and experimental evidence suggests that interleukin-1 blockade is effective against myocardial inflammation and contractile dysfunction, thus representing a promising candidate for the treatment of inflammatory heart failure. Although further confirmation is needed, these encouraging results indicate that anakinra may be a suitable treatment for fulminant myocarditis. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/1VeDC2M
Εγγραφή σε:
Σχόλια ανάρτησης (Atom)
Δημοφιλείς αναρτήσεις
-
This feed no longer exists. Cambridge Journals Online and Cambridge Books Online have been replaced by Cambridge University Press’s new acad...
-
Abstract In this work, novel thin-film composite forward osmosis (TFC-FO) hollow fiber membranes were fabricated by modifying polyamide ac...
-
Objectives: Opioids and benzodiazepines are commonly used to provide analgesia and sedation for critically ill children with cardiac disease...
-
Objective: Inotropic and vasopressor drugs are routinely used in critically ill patients to maintain adequate blood pressure and cardiac ou...
-
Academic Emergency Medicine, EarlyView. from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2Lq7OXW
-
Abstract The dispersion properties of Love waves are utilized for the fabrication of sensor devices in the different material environments...
-
Plasminogen activator inhibitor-1 gene polymorphisms in systemic lupus erythematosus: is there a risk for lupus nephritis among Egyptians? A...
-
EMS providers should be on high alert for fraud and forgery in the patient care report from EMS via xlomafota13 on Inoreader https://ift.t...
Δεν υπάρχουν σχόλια:
Δημοσίευση σχολίου