Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease
An adult with surgically corrected Tetralogy of Fallot presented with profoundly elevated central venous pressure (CVP) and acute renal dysfunction thought secondary to acute on chronic right heart failure. Treatment with dopamine promoted diuresis and a stabilization of renal function. Repeated att...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2020/7148708 |
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| author | Wytch Rigger Sean P. Javaheri Gyanendra K. Sharma Norris Stanley Nahman Mark Sheynshteyn Neal L. Weintraub |
| author_facet | Wytch Rigger Sean P. Javaheri Gyanendra K. Sharma Norris Stanley Nahman Mark Sheynshteyn Neal L. Weintraub |
| author_sort | Wytch Rigger |
| collection | DOAJ |
| description | An adult with surgically corrected Tetralogy of Fallot presented with profoundly elevated central venous pressure (CVP) and acute renal dysfunction thought secondary to acute on chronic right heart failure. Treatment with dopamine promoted diuresis and a stabilization of renal function. Repeated attempts to wean the patient from dopamine were associated with hypotension and worsening renal failure. Invasive hemodynamic assessment unexpectedly demonstrated high cardiac output with low systemic vascular resistance (SVR). In retrospect, the markedly elevated CVP had concealed the impact of reduced SVR on blood pressure. After reversible causes of low SVR state were excluded, the patient was successfully managed with oral alpha-adrenergic agents. While typically negligible under physiologic conditions, elevated CVP can artificially increase mean arterial pressure. We have coined the term “masked hypotension” to describe this unique pathophysiological phenomenon. |
| format | Article |
| id | doaj-art-2c512702e8aa4b14b3580b100982f775 |
| institution | Kabale University |
| issn | 2090-6404 2090-6412 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Cardiology |
| spelling | doaj-art-2c512702e8aa4b14b3580b100982f7752025-02-03T01:05:00ZengWileyCase Reports in Cardiology2090-64042090-64122020-01-01202010.1155/2020/71487087148708Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart DiseaseWytch Rigger0Sean P. Javaheri1Gyanendra K. Sharma2Norris Stanley Nahman3Mark Sheynshteyn4Neal L. Weintraub5Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USADivision of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USADivision of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USADivision of Nephrology, Medical College of Georgia at Augusta University, Augusta, GA, USADivision of Endocrinology, Diabetes and Metabolism, Medical College of Georgia at Augusta University, Augusta, GA, USADivision of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA, USAAn adult with surgically corrected Tetralogy of Fallot presented with profoundly elevated central venous pressure (CVP) and acute renal dysfunction thought secondary to acute on chronic right heart failure. Treatment with dopamine promoted diuresis and a stabilization of renal function. Repeated attempts to wean the patient from dopamine were associated with hypotension and worsening renal failure. Invasive hemodynamic assessment unexpectedly demonstrated high cardiac output with low systemic vascular resistance (SVR). In retrospect, the markedly elevated CVP had concealed the impact of reduced SVR on blood pressure. After reversible causes of low SVR state were excluded, the patient was successfully managed with oral alpha-adrenergic agents. While typically negligible under physiologic conditions, elevated CVP can artificially increase mean arterial pressure. We have coined the term “masked hypotension” to describe this unique pathophysiological phenomenon.http://dx.doi.org/10.1155/2020/7148708 |
| spellingShingle | Wytch Rigger Sean P. Javaheri Gyanendra K. Sharma Norris Stanley Nahman Mark Sheynshteyn Neal L. Weintraub Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease Case Reports in Cardiology |
| title | Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease |
| title_full | Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease |
| title_fullStr | Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease |
| title_full_unstemmed | Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease |
| title_short | Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease |
| title_sort | masked hypotension due to elevated venous pressure in a patient with complex adult congenital heart disease |
| url | http://dx.doi.org/10.1155/2020/7148708 |
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