• PDF / 172,434 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 40 Downloads / 203 Views

DOWNLOAD

REPORT

---

1 S

Nitric-oxide/sildenafil Decompensated heart failure and dyspnoea leading to pulse-less electrical activity and an increased pulmonary artery wedge pressure: case report

A 59-year-old woman developed decompensated heart failure and dyspnoea leading to pulse-less electrical activity (PEA) arrest during treatment with sildenafil for pulmonary hypertension, and an increased pulmonary artery wedge pressure (PAWP) during treatment with nitric-oxide for pulmonary hypertension [not all routes and dosages stated; durations of treatments to reactions onsets not stated]. The woman, who had end stage renal disease, carcinoid lung tumor status post-left pneumonectomy 20 years previously without residual disease and an ischaemic cardiomyopathy with a left ventricular ejection fraction of 25%, presented after recurrent pulseless electrical activity arrests. Several months previously, right heart catheterisation showed a mean pulmonary artery pressure (MPAP) of 55mm Hg, pulmonary artery wedge pressure (PAWP) of 16mm Hg and pulmonic vascular resistance of 9.5 Wood Units consistent with pulmonary hypertension. Therefore, she started receiving sildenafil [initial dose not stated], which was uptitrated to 40mg three times per day. Subsequently, she developed several episodes of dyspnoea leading to pulseless electrical activity arrest. She was intubated during these PEA arrest episodes, and frothy secretions were observed during each episode. Coronary angiography revealed stable ischaemic disease. Pulmonary oedema was treated with aggressive ultrafiltration. The woman was considered to have acute decompensated heart failure secondary to sildenafil use. Her sildenafil therapy was withheld. She was treated with inhaled nitric-oxide. Subsequently, end-diastolic PAWP increased from 12mm Hg to 21mm Hg with large V waves to 33mm Hg. Her mean PAWP was ≈26mm Hg. Sildenafil was stopped permanently, and she experienced no recurrent episodes at 8-month follow-up [not all outcomes stated]. El Hajj MC, et al. Recurrent but Preventable Pulseless Electrical Activity Arrest: Follow the Guidelines!. Circulation: Heart Failure 13: No. 3, Mar 2020. Available from: 803500558 URL: http://doi.org/10.1161/CIRCHEARTFAILURE.119.006781

»

Editorial comment: Details of this case report have previously been published and processed for Adis PV [see Reactions 1751 p286; 803389362].

0114-9954/20/1821-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 12 Sep 2020 No. 1821