A 27-year-old with suspected fulminant myocarditis has LVEF 15%, ventricular ectopy, lactate 6 mmol/L and worsening shock despite norepinephrine and

Question

A 27-year-old with suspected fulminant myocarditis has LVEF 15%, ventricular ectopy, lactate 6 mmol/L and worsening shock despite norepinephrine and dobutamine. Coronary angiography is normal. What is the next systems-level action?

Accepted Answer

Activate the shock team and transfer for temporary mechanical circulatory support assessment

Answer

Use large repeated crystalloid boluses until central venous pressure is markedly elevated

Answer

Give fibrinolysis because a normal coronary angiogram suggests spontaneous reperfusion of STEMI

Answer

Arrange outpatient cardiac MRI before deciding whether monitored admission is required

Answer

Increase beta-blocker therapy rapidly because tachycardia is the principal cause of the low ejection fraction

Acute myocarditis — RCPSC EM MCQ

A 27-year-old with suspected fulminant myocarditis has LVEF 15%, ventricular ectopy, lactate 6 mmol/L and worsening shock despite norepinephrine and dobutamine. Coronary angiography is normal. What is the next systems-level action?