Universität zu Köln

Dumitrescu, D., Gerhardt, F., Viethen, T., Erdmann, E. and Rosenkranz, S. (2011). 70-year-old woman with cardiac hypertrophy and severe pulmonary hypertension: pre- or postcapillary? Dtsch. Med. Wochenschr., 136 (50). S. 2594 - 2599. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-4413

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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). 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). 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. 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Dumitrescu, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerhardt, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Viethen, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Erdmann, E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rosenkranz, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-483907
DOI:	10.1055/s-0031-1292855
Journal or Publication Title:	Dtsch. Med. Wochenschr.
Volume:	136
Number:	50
Page Range:	S. 2594 - 2599
Date:	2011
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-4413
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CHRONIC HEART-FAILURE; PRESSURE Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/48390