Influenza A virus infectiontriggering mycocardial infarction and acute heart failue

Kuşoğlu H.

Uluslarası Akademik Geriatri Kongresi, Antalya, Turkey, 12 - 16 April 2017, pp.100-101

  • Publication Type: Conference Paper / Summary Text
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.100-101
  • Acibadem Mehmet Ali Aydinlar University Affiliated: Yes


INFLUENZA A VIRUS INFECTION TRIGGERING MYOCARDIAL INFARCTION AND ACUTE HEART FAILURE Utku Zor1, Hülya Kuşoğlu2 1 Acibadem Fulya Hospital,cardiology 2 Acibadem Univesity School of Medicine,ınfectious Diseases And Clinical Microbiology Introduction: Influenza infection can lead to serious complications in people having underlying medical disorders such as cardiovascular diseases. It is known that Influenza viruses have direct effect on the myocardium and can also lead to exacerbations of existing cardiovascular diseases. Geriatric patients are at high risk of morbidity and mortality during an Influenza infection. Case presentation: An 85-year-old woman was admitted to the hospital with fever, chest pain and shortness of breath present for 2 days. Her past medical history included coronary artery disease, aortic valve stenosis, hypertension, hyperlipidemia and hypothyroidism. She underwent a coronary artery by-pass and a bioprosthetic valve replacement operation 4 years ago. Her physical examination revealed tachypnea with breaths 34/minute. Respiratory sounds were compatible with paninspiratory rales blaterally at lower and mid regions. At room air her O2 saturation rate was 85%. Cardiovascular assessment showed jugular venous distention, a S4 gallop rhythm, an apical 3/6 pansystolic murmur, an aortic 2/6 systolic ejection murmur. Her blood pressure was to be 158/60 mmHg, heart rate was 112 beats/min. Pretibial edema was observed. Her chest X-ray showed bilateral pulmonary vascular cephalization, infiltrates suggesting alveolar edema. ECG revealed pathological Q-waves on the inferior derivations, a 1-mm- ST depression on the precordial leads V4,V5 and V6. Echocardiography revealed a decrease in her left ventricular ejection fraction rate of 40% (N: >55%) which was known to be 55-60% on her previous Echocardiography. Basal inferolateral wall was akinetic as before but severe basal and mid anterolateral motion hypokinesia were new findings. The mitral valvular structure was normal, but severe functional mitral regurgitation was seen. The bioprosthetic aortic valve was functioning normally. Her first laboratory results showed a Troponin I as 3.066ng/mL (N:<0.04);NT Pro BNP 7340 pg/mL (N:<738). A rapid Influenza testing resulted positive for Influenza A. With these findings the patient was admitted to the Intensive care unit with the diagoses of acute coronary syndrome and acute heart failure, developed during an influenza infection. Mechanical ventilation was performed and she was given acetylsalycylic acid, ticagralor, nitroglycerin and furosemide infusion. Enoxaparin was started after her INR level dropped below 2.0. Influenza infection was treated with oseltamivir for 5 days. Her previous angiography was re-assessed;many lesions which were not amenable to revascularization and supplying the newly diagnosed hypokinetic regions were determined. A new angiography was not performed, with the decision of continuing medical therapy. Discussion: This case is a good example of increased risk for cardiovascular mortality and morbidity during influenza infections and emphasizes the role of Influenza vaccination in vulnerable patients such as those with coronary artery disease. Keywords: Acute myocardial infarction, Acute heart failure, Influenza infection