What is the cause of acute left ventricular (LV) dysfunction with chills?

From the Guidelines

Acute left ventricular (LV) dysfunction with chills is a serious cardiac emergency that requires immediate hospitalization and treatment to stabilize cardiac function and address the underlying cause, which may include severe infections like sepsis, myocarditis, or acute coronary syndromes, as supported by the most recent guidelines 1. The condition is characterized by a sudden impairment in the heart's left ventricle pumping ability, accompanied by shivering and feelings of cold, which can rapidly progress to cardiogenic shock and multi-organ failure if not properly managed.

• The chills often result from the body's inflammatory response or fever associated with the underlying cause.
• Treatment depends on the specific cause but generally includes:
  • Stabilizing cardiac function with medications like diuretics (furosemide 20-40mg IV) to reduce fluid overload.
  • Vasopressors if hypotensive (norepinephrine 0.1-0.5 mcg/kg/min) to maintain adequate blood pressure.
  • Inotropes such as dobutamine (2.5-10 mcg/kg/min) to improve heart contractility.
• If infection is suspected, broad-spectrum antibiotics should be started promptly after blood cultures are obtained, as recommended by guidelines 1.
• Oxygen therapy and possibly mechanical ventilation may be needed for respiratory support.
• Continuous cardiac monitoring is essential, and an echocardiogram should be performed urgently to assess ventricular function, as emphasized in the guidelines 1. This condition requires immediate attention and treatment to prevent morbidity, mortality, and to improve quality of life, as highlighted in the guidelines 1.

From the Research

Definition and Causes of Acute LV Dysfunction

• Acute left ventricular (LV) dysfunction is common in the critical care setting and more frequently affects the elderly and patients with comorbidities 2.
• It can be caused by various factors, including acute coronary syndrome, stress (takotsubo) cardiomyopathy, and the cardio-depressant effect of inflammatory mediators and endotoxins in septic shock 2.
• Tachycardia, hypertension, and severe metabolic abnormalities can also independently cause global LV dysfunction, which typically improves with addressing the precipitating factor 2.

Symptoms and Diagnosis

• Acute LV dysfunction can present with symptoms such as heart failure, arrhythmias, and dynamic LV outflow tract obstruction 2.
• Routine troponin testing may help early detection of cardiac injury, and biomarkers could have prognostic value independent of prior cardiac disease 2.
• Echocardiography is ideally suited to quantify LV dysfunction and determine its most likely cause 2.

Treatment and Management

• Early diagnosis and treatment of acute LV dysfunction are crucial to improve outcomes 2, 3.
• Management of acute LV dysfunction after primary percutaneous coronary intervention for ST elevation acute myocardial infarction involves a thorough clinical and instrumental evaluation to discriminate patients who will likely recover from those who have irreversible myocardial injury 3.
• Treatment options may include pharmacological management, patient counseling and education, exercise and rehabilitation, and evaluation for myocardial revascularization 4.

Prognosis and Outcomes

• LV dysfunction suggests a worse prognosis, but with appropriate therapy, outcomes can be optimized 2.
• The benefits of treatment on all outcomes are independent of age, sex, and baseline use of diuretics, aspirin, and beta-blockers 5.
• Mortality is high in patients with heart failure, with 5-year mortality in the range of 50 percent 4.