CARDIOGENIC SHOCK SECONDARY TO HUMAN IMMUNODEFICIENCY VIRUS INDUCED MYOCARDITIS
Recommended Citation
Andrews TQ, McBride P, Abdelhai OS, Toiv A, Zimmerman A, Cowger JA. CARDIOGENIC SHOCK SECONDARY TO HUMAN IMMUNODEFICIENCY VIRUS INDUCED MYOCARDITIS. J Am Coll Cardiol 2025; 85(12):3210.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
J Am Coll Cardiol
Keywords
bictegravir, CD4 antigen, dolutegravir, emtricitabine, tenofovir, adult, cardiogenic shock, cardiomyopathy, case report, clinical article, conference abstract, diagnosis, differential diagnosis, drug therapy, dyspnea, hemodynamics, highly active antiretroviral therapy, human, Human immunodeficiency virus infection, left ventricular assist device, male, medical history, myocarditis, New York Heart Association class, ventricular assist device, virus load
Abstract
Background: HIV associated cardiomyopathy is a stage IV defining HIV illness conferring increased mortality among infected individuals. Favorable outcomes rely on an interdisciplinary care approach. Case A 28-year-old male with no medical history or high risk social features presented to outside hospital with dyspnea and found in cariogenic shock (CGS) with positive HIV PCR. He escalated to intermediate hospital for Impella CP then to HFH where Impella was upgraded to 5.5. HIV viral load was 3.8M copies with low CD4. HAART was started with emtricitabine/tenofovir and Dolutegravir. At week two, LVEF improved to 33% with hemodynamic stabilization. The Impella was removed and the patient tolerated GDMT. Repeat HIV viral load of 172 copies. He was transitioned to bictegravir/emtrcitabine/tenofovir and discharged. At four weeks post-discharge, he was NYHA I-II on four-pillar GDMT. Decision-making Even in 2024, HIV should be considered in the differential diagnosis of acute myocarditis as risks for HIV may not be readily shared. Prompt consideration of HIV, initiation of HAART, and aggressive stabilization through MCS was essential in managing the underlying process. Conclusion This case highlights a potentially reversible cardiomyopathy with a complex interplay of acute HIV myocarditis and CGS. The patientʼs significant improvement, evidenced by reduced HIV viral load and successful weaning from MCS, underscores the effectiveness of a multidisciplinary approach. [Formula presented]
Volume
85
Issue
12
First Page
3210
