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[70-year-old woman with cardiac hypertrophy and severe pulmonary hypertension: pre- or postcapillary?].
- Source :
-
Deutsche medizinische Wochenschrift (1946) [Dtsch Med Wochenschr] 2011 Dec; Vol. 136 (50), pp. 2594-8. Date of Electronic Publication: 2011 Dec 07. - Publication Year :
- 2011
-
Abstract
- History and Admission Findings: A 70-year-old female patient was admitted with progressive dyspnea and peripheral edema. The patient had a medical history of myocardial hypertrophy, diastolic dysfunction and concomitant pulmonary hypertension (PH).<br />Investigations: The physical exam was suggestive of cardiac decompensation. Echocardiography showed myocardial hypertrophy, an enlarged left atrium as well as enlarged right-sided heart chambers. A prominent tricuspid regurgitation jet was present, and the estimated systolic right ventricular pressure was 65 mmHg. Invasive hemodynamic measurements showed a marked pressure elevation in the pulmonary circulation (mean PAP 51 mmHg), combined with an elevated left ventricular end-diastolic pressure (LVEDP) of 30 mmHg and a profound increase in the transpulmonary gradient (TPG, 21 mmHg).<br />Treatment and Course: The synopsis of these findings led to the diagnosis of postcapillary PH with a prominent precapillary involvement and cardiac decompensation. Due to signs of volume overload, an adequate diuretic therapy was initiated. The patient was recompensated and lost 7 kg of weight, which was associated with substantial clinical improvement. At invasive follow-up hemodynamic measurement, the patient's PAP was substantially decreased and almost reached normal values. The previously diagnosed precapillary involvement had disappeared.<br />Conclusion: PH is a frequent phenomenon in patients with systolic and diastolic heart failure, and might initially appear as a combination of pre- and postcapillary involvement. The patients' volume status has a major influence on pulmonary hemodynamics. An adequate therapy of the underlying heart failure, especially an adequate diuresis, may have marked beneficial effects on pulmonary hemodynamics. Hemodynamic measurements should always be performed in compensated status.<br /> (© Georg Thieme Verlag KG Stuttgart · New York.)
- Subjects :
- Aged
Blood Volume drug effects
Cardiac Catheterization
Cardiomegaly drug therapy
Diagnosis, Differential
Diuretics therapeutic use
Echocardiography
Female
Heart Failure, Diastolic diagnosis
Heart Failure, Diastolic drug therapy
Hemodynamics drug effects
Hemodynamics physiology
Humans
Hypertension, Pulmonary drug therapy
Pulmonary Wedge Pressure drug effects
Pulmonary Wedge Pressure physiology
Tricuspid Valve Insufficiency diagnosis
Tricuspid Valve Insufficiency drug therapy
Vascular Resistance drug effects
Cardiomegaly diagnosis
Dyspnea etiology
Edema, Cardiac etiology
Hypertension, Pulmonary diagnosis
Subjects
Details
- Language :
- German
- ISSN :
- 1439-4413
- Volume :
- 136
- Issue :
- 50
- Database :
- MEDLINE
- Journal :
- Deutsche medizinische Wochenschrift (1946)
- Publication Type :
- Academic Journal
- Accession number :
- 22160952
- Full Text :
- https://doi.org/10.1055/s-0031-1292855