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We report a 31-year-old patient with acute fulminant myocarditis, resulting in cardiogenic shock that necessitated mechanical circulatory support, who improved dramatically after treatment with intravenous (IV) pulse steroids. A coordinated multidisciplinary team was the key secret in the cure of this critical patient. In this case study, we focus on the role of IV pulse steroids in the treatment of fulminant lymphocytic myocarditis.

Introduction: Heart failure with reduced ejection fraction (HFrEF) in Qatar has not been well characterized in the outpatient setting. Objective: To describe the characteristics of patients with HFrEF who had improvement in their left ventricular ejection fraction (LVEF) and independent predictors of improvement. Methods: This retrospective cohort study conducted at the advanced heart failure (HF) clinic in Qatar recruited patients who visited the clinic between January 2017 and December 2018. Adult patients were eligible if they were diagnosed with HFrEF (LVEF < 40%) and had two echocardiograms separated by at least 6 months. Results: Of 582 eligible patients, 161 (27.7%) had improved LVEF. They were younger (53.4 vs. 57.3 years, P = 0.002) and had shorter duration of HF diagnosis (4.3 vs. 5.6 years, P = 0.001). They experienced lower rates of all-cause hospitalization (20.5% vs. 38.0%, P = 0.001) and emergency department visits (25.5% vs. 35.9%, P = 0.001), without a difference in hospital mortality rate, than those without LVEF improvement. Decreased odds ratio of improved LVEF was associated with per year increase in age (adjusted odds ratio [aOR]: 0.98, 95% confidence interval [CI]: 0.97–0.99, P = 0.03), presence of left bundle branch block (aOR: 0.40, 95% CI: 0.20–0.80, P = 0.001), duration of HF diagnosis (aOR: 0.85, 95% CI: 0.78–0.94, P = 0.001), and ischemic HF etiology (aOR: 0.50, 95% CI: 0.30–0.77, P = 0.001; compared with dilated etiology). Beta-blocker therapy was associated with higher odds of LVEF improvement (aOR: 2.65, 95% CI: 1.02–6.88, P = 0.001). Conclusion: Patients with HFrEF with improved LVEF were younger, had a nonischemic cardiomyopathy, and had significantly fewer hospitalizations and emergency department visits.

BackgroundAcute coronary syndrome (ACS) remains a risk factor for heart failure (HF). Therefore, we aimed to assess the cardioprotective role of sodium–glucose cotransporter-2 (SGLT2) inhibitors post-ACS in patients with acute HF (AHF) and diabetes.MethodsWe conducted a retrospective observational cohort study employing propensity score matching. This study involved patients with diabetes admitted with ACS complicated by AHF, defined as either new clinical HF requiring diuretics during the index admission or having an ejection fraction (EF) of

Patients at each shock stage may behave and present differently with a spectrum of shock severity and adverse outcomes. Shock severity, shock aetiology, and several factors should be integrated in management decision-making. Although the contemporary shock stages classification provided a standardized shock severity assessment, individual agents or management strategy has not yet been studied in the context of each shock stage. The pre-shock state may comprise a wide range of presentations. Nitrate therapy has potential benefit in myocardial infarction and acute heart failure. Herein, this review aims to discuss the potential use of nitrate therapy in the context of the pre-shock state or stage B of the contemporary shock classification given its various presentations.

We report the case of acute lymphoblastic leukemia (ALL) in a 29-year-old male with no past medical history who presented with symptoms and signs of heart failure due to possible infiltrative cardiomyopathy as suggested by echocardiography. Workup including different imaging modalities confirmed the diagnosis of ALL. The patient completed his treatment course with a resolution of heart failure symptoms and normalization of cardiac function which was confirmed by different imaging modalities.