ArticleEuropean heart journal. Case reports2022
Unloading the right to fill the left: vasodilation to treat hypotension: a case report.
Article in European heart journal. Case reports, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Management of pulmonary hypertension (PH) in the setting of heart failure with preserved ejection fraction (HFpEF) can be challenging. Herein, we describe the case of a patient with HFpEF and combined pre- and post-capillary PH who showed striking improvement with sildenafil. Case summary: A 74-year-old man presented with exertional dyspnea and near-syncope. He underwent a hemodynamic exercise study that showed evidence of HFpEF with pre- and post-capillary PH. Right ventricular endomyocardial biopsy showed interstitial fibrosis and mild hypertrophy, with no evidence of infiltrative or storage diseases. The patient was treated with sildenafil 20 mg three times daily, which resulted in significant symptomatic and functional improvement in 12 years of follow-up. Discussion: Phosphodiesterase 5 inhibitors are currently not approved by the United States Food and Drug Administration for treatment of PH in heart failure and are used off-label in patients with heart failure. This case illustrates the importance of unloading the right ventricle to improve cardiac output in patients with diastolic dysfunction and combined pre- and post-capillary PH. Although promising, future studies are needed to validate these findings.
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