Home inotrope therapy in chronic stimulant-induced cardiomyopathy: a case series.
Publication/Presentation Date
8-1-2024
Abstract
BACKGROUND: Patients with chronic stimulant-induced cardiomyopathy presenting with cardiogenic shock can be stabilized with conventional measures. However, their management post-stabilization has not been well described and poses unique challenges: (i) less chance of myocardial recovery compared to acute stimulant-induced cardiomyopathy, (ii) psychosocial barriers to left ventricular assist device (LVAD) and heart transplantation, and (iii) concern for use of peripherally inserted central catheter for home inotrope in those with a history of substance abuse.
CASE SUMMARY: Three patients with chronic stimulant-induced cardiomyopathy were admitted with cardiogenic shock progressing to Society for Cardiovascular Angiography & Interventions stage D or E. They were stabilized with inotrope and/or biventricular mechanical circulatory support. Long-term home inotrope was used as either a bridge to LVAD, reverse remodelling, or stabilization.
DISCUSSION: Home inotrope should be viewed as an option in chronic stimulant-induced cardiomyopathy on a case-by-case basis. It can buy time to allow for myocardial stabilization or recovery through goal-directed medical therapy and stimulant cessation. It can also serve as a 'psychosocial stress test' for future consideration of advanced heart failure therapies.
Volume
8
Issue
8
First Page
406
Last Page
406
ISSN
2514-2119
Published In/Presented At
Joseph, M., Batra, S., Kamran, W., Barrett, K., Ebert, B., Nassar, A., Misselbeck, T., & Hawwa, N. (2024). Home inotrope therapy in chronic stimulant-induced cardiomyopathy: a case series. European heart journal. Case reports, 8(8), ytae406. https://doi.org/10.1093/ehjcr/ytae406
Disciplines
Medicine and Health Sciences
PubMedID
39171134
Department(s)
Department of Medicine, Cardiology Division, Department of Medicine Fellows and Residents, Fellows and Residents, USF-LVHN SELECT Program, USF-LVHN SELECT Program Faculty, USF-LVHN SELECT Program Students
Document Type
Article