Treprostinil
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High out-put cardiac failure: case report A 56-year-old man developed high out-put cardiac failure during treatment with treprostinil for pulmonary hypertension. The man presented to the hospital with subacute-on-chronic hypoxemic respiratory failure and new ascites. He had a history of pulmonary hypertension, for which he had been receiving SC treprostinil [Remodulin] along with sildenafil and home oxygen for 3 years. He also had compensated cirrhosis because of alcohol abuse. After admission, his chest CT showed a large pericardial effusion, dilated main pulmonary artery, splenomegaly and cirrhotic liver with ascites. Transthoracic echocardiogram (TTE) demonstrated a large pericardial effusion and right ventricular hypertrophy. Right ventricle to left ventricle ratio was 1.25:1. Thereafter, the man was transferred to the ICU for the drainage of ascites, but was deferred because of pulmonary hypertension. He underwent paracentesis, which showed transudative picture. His serum-ascites albumin gradient (SAAG) was >1.1, which was suggestive of portal hypertension, and his high ascetic protein was indicative of cardiac causes of portal hypertension. Pulmonary artery catheterization showed cardiac index of 5.7 L/min/m2 and cardiac output of 11.2 L/min, systemic vascular resistance of 593 dynes sec/cm-5, pulmonary artery mean pressure of 42 mmHg and wedge of 11 mmHg, suggestive of high-output heart failure secondary to treprostinil treatment. Treprostinil dose was reduced by 10% every 8–12 hours along with assessment of haemodynamic changes. Eventually, treprostinil dose was decreased from 176 ng/kg/min to 105 ng/kg/min. Following dose reduction of treprostinil, pulmonary artery catheterisation showed cardiac index of 3.4 L/min/m2 and cardiac output of 6.7 L/min, systemic vascular resistance of 988 dynes sec/cm-5 and pulmonary artery mean pressure of 41 mmHg. His shortness of breath improved, following which he was transferred to regular floors [duration of treatment to reaction onset not stated]. Syed A, et al. High out-put cardiac failure secondary to high dose prostacyclin therapy for pulmonary hypertension. American Journal of Respiratory and Critical Care Medicine 199: (plus poster) abstr. A1931, No. 9, May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1931 [abstract] 803447096
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Reactions 18 Jan 2020 No. 1787
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