Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case report
Abstract Background Plasma exchange (PE) removes high-molecular-weight substances and is sometimes used for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with alveolar hemorrhage. Hypotension during PE is rare, except in allergic cases. We report a case of shock likely caused by in...
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SpringerOpen
2025-01-01
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| Series: | JA Clinical Reports |
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| Online Access: | https://doi.org/10.1186/s40981-025-00765-0 |
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| author | Takayuki Toki Kazuyuki Mizunoya Misa Itabashi Naoki Nishikawa Koji Hoshino Hitoshi Saito Yuji Morimoto |
| author_facet | Takayuki Toki Kazuyuki Mizunoya Misa Itabashi Naoki Nishikawa Koji Hoshino Hitoshi Saito Yuji Morimoto |
| author_sort | Takayuki Toki |
| collection | DOAJ |
| description | Abstract Background Plasma exchange (PE) removes high-molecular-weight substances and is sometimes used for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with alveolar hemorrhage. Hypotension during PE is rare, except in allergic cases. We report a case of shock likely caused by increased pulmonary vascular resistance (PVR) during PE. Case presentation A 66-year-old man with pulmonary hypertension (PH) and glomerulonephritis was admitted with dyspnea. He had discontinued sildenafil prior to admission. Alveolar hemorrhage associated with AAV was suspected, and PE was performed. Soon after, he developed circulatory failure and hyperlactatemia. Echocardiography revealed right ventricular dilation, suggesting increased PVR. Inhaled nitric oxide (iNO) was administered, rapidly improving hyperlactatemia and oxygenation. The shock observed during PE was attributed to multiple factors, including the potential removal of sildenafil, which may have led to an increase in PVR. Conclusions The shock was attributable to acute right heart failure caused by an exacerbation of PH, possibly due to sildenafil removal via PE, although other contributing factors could not be excluded. |
| format | Article |
| id | doaj-art-87992fd38aa842f38483f90aa5330636 |
| institution | Kabale University |
| issn | 2363-9024 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
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| series | JA Clinical Reports |
| spelling | doaj-art-87992fd38aa842f38483f90aa53306362025-02-02T12:12:25ZengSpringerOpenJA Clinical Reports2363-90242025-01-011111510.1186/s40981-025-00765-0Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case reportTakayuki Toki0Kazuyuki Mizunoya1Misa Itabashi2Naoki Nishikawa3Koji Hoshino4Hitoshi Saito5Yuji Morimoto6Department of Anesthesiology and Critical Care Medicine, Hokkaido University HospitalDepartment of Anesthesiology and Critical Care Medicine, Hokkaido University HospitalDepartment of Anesthesiology and Critical Care Medicine, Hokkaido University HospitalDepartment of Anesthesiology and Critical Care Medicine, Hokkaido University HospitalDepartment of Anesthesiology and Critical Care Medicine, Hokkaido University HospitalDepartment of Anesthesiology and Critical Care Medicine, Hokkaido University HospitalDepartment of Anesthesiology and Critical Care Medicine, Hokkaido University HospitalAbstract Background Plasma exchange (PE) removes high-molecular-weight substances and is sometimes used for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with alveolar hemorrhage. Hypotension during PE is rare, except in allergic cases. We report a case of shock likely caused by increased pulmonary vascular resistance (PVR) during PE. Case presentation A 66-year-old man with pulmonary hypertension (PH) and glomerulonephritis was admitted with dyspnea. He had discontinued sildenafil prior to admission. Alveolar hemorrhage associated with AAV was suspected, and PE was performed. Soon after, he developed circulatory failure and hyperlactatemia. Echocardiography revealed right ventricular dilation, suggesting increased PVR. Inhaled nitric oxide (iNO) was administered, rapidly improving hyperlactatemia and oxygenation. The shock observed during PE was attributed to multiple factors, including the potential removal of sildenafil, which may have led to an increase in PVR. Conclusions The shock was attributable to acute right heart failure caused by an exacerbation of PH, possibly due to sildenafil removal via PE, although other contributing factors could not be excluded.https://doi.org/10.1186/s40981-025-00765-0Plasma exchangeComplicationsPulmonary vascular resistancePulmonary hypertensionSildenafil |
| spellingShingle | Takayuki Toki Kazuyuki Mizunoya Misa Itabashi Naoki Nishikawa Koji Hoshino Hitoshi Saito Yuji Morimoto Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case report JA Clinical Reports Plasma exchange Complications Pulmonary vascular resistance Pulmonary hypertension Sildenafil |
| title | Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case report |
| title_full | Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case report |
| title_fullStr | Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case report |
| title_full_unstemmed | Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case report |
| title_short | Acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange: a case report |
| title_sort | acute decompensated right heart failure potentially triggered by multiple factors including pulmonary vasodilator removal during plasma exchange a case report |
| topic | Plasma exchange Complications Pulmonary vascular resistance Pulmonary hypertension Sildenafil |
| url | https://doi.org/10.1186/s40981-025-00765-0 |
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