Multiple drugs

Abstract

Lack of efficacy: case report A 60-year-old woman exhibited lack of efficacy with amiodarone, immune-globulin, lidocaine, methylprednisolone, mycophenolate and tacrolimus, while being treated for ventricular tachyarrhythmias (VT) and giant cell myocarditis [dosages not stated; not all routes not stated]* . The woman presented with dyspnoea. PE workup was negative EKG showed anterior ST elevation. LHC did not show any evidence of CAD, echo revealed EF of 10%. She had sustained VT. Subsequently, she was treated with amiodarone and transferred to hospital for advanced heart failure evaluation. On admission, intra-aortic balloon pump (IABP) was placed without much improvement in the haemodynamics. She was started on amiodarone and lidocaine. Endomyocardial biopsy was performed. Despite IABP, she had signs of hypo-perfusion and extracorporeal membrane oxygenation (ECMO) was was initiated. Preliminary pathology showed severe inflammation with some giant cells. She was started on IV methylprednisolone, IV immune-globulin [IVIG], low-dose tacrolimus and mycophenolate. Despite these, she remained in polymorphic VT and no signs of myocardial recovery was noted. After initial transplant evaluation at orthotopic heart transplantation was performed. Post-transplant, graft did not had adequate LV function and she was continued on ECMO. Her haemodynamics were maintained on IV pressors and inotropes. Her VA ECMO and off pressors were weaned off. Pathology of the explanted heart showed diffuse myocardial infiltrates of lymphocytes and histiocytes with numerous giant cells, suggested giant cell myocarditis.