At 14:34, on February 16, 2023, City Children’s Hospital received 11-year-old LBTA children, female, living in Phuoc Vinh, Phu Giao, Binh Duong. Taking the patient’s medical history for 3 days, N1-2 showed mild fever, fatigue, abdominal pain, vomiting, and loose stools once. On the morning of N3 the child went to school, fainted during exercise, was taken to a local hospital in a state of shock, arrhythmia, elevated tropin I test, respiratory support, adrenaline infusion, transferred to a Children’s Hospital City Council.
Here: drowsy child, pale lips, cool extremities, CRT > 3 seconds, blood pressure drop 70/50 mmHg, jugular venous distention, slight radial pulse difficult to catch, irregular heartbeat, monitor ventricular rate 180-200 times/ Minutes, ECG measurement recorded ventricular tachycardia, breathing 26 breaths/minute, lungs are not rales, lung sounds are both sides, abdomen is soft, liver 3cm right lower abdomen, neck is soft, no rash on hands and feet, no signs of mucosal bleeding . Cardiac enzyme test Troponin I, CK-MB increased, echocardiography reduced the ejection fraction EF to 18-22% (normal EF 60-80%).
Diagnosis: Fulminant myocarditis, cardiogenic shock, arrhythmia. Management: the child was intubated for breathing, vasopressor adrenaline, dobutamine, used antiarrhythmic drug lidocaine, consulted the ECMO team to conduct femoral artery and femoral vein cannula placement, priming the ECMO machine system, connect to VA ECMO mode patient. Children continue to be treated with antiarrhythmic drugs lidocaine in combination with cordarone, blood transfusion, platelets, electrolytes, acidosis, ECMO systemic anticoagulation with heparin, diuretics to reduce left ventricular load, antibiotics for treatment. pulmonary superinfection. Results after 8 days of running ECMO, the doctors tried to handle the abnormal changes in the child’s heart rate, myocardium and hemodynamics, as well as supportive treatment for other organs, finally the child’s heart gradually recovered. , ventricular tachyarrhythmia, ventricular fibrillation to sinus rhythm, improvement in ejection fraction EF 50-55%, blood pressure stable when doing ECMO machine calibrator test. The child was weaned from ECMO, the vascular cannula was removed, and continued to receive supportive treatment in the intensive care unit.
Through this case, we pay attention to parents in the Tet season, after Tet in January, February, and March, there are often cases of viral infections, complications of myocarditis, older children, adults with mild fever, tired people. , headache, vomiting, abdominal pain, pale face, pale hands and feet, pale toenails, fainting, chest pain, .. quickly take the child to a medical facility that specializes in pediatrics for examination and diagnosis. Early diagnosis of myocarditis and appropriate management.
11-year-old LBTA child, female, fulminant myocarditis, cardiogenic shock, severe arrhythmia, actively treated with mechanical ventilation, ECMO, antiarrhythmic drugs.
After 8 days of ECMO treatment, the child was weaned off ECMO, weaned off the ventilator, and were awake
Doctor 2 Nguyen Minh Tien
City Children’s Hospital