RT Book, Section A1 Pleister, Adam A1 Hasan, Ayesha A2 Gulati, Martha SR Print(0) ID 1128087933 T1 HEART FAILURE IN WOMEN T2 Color Atlas and Synopsis of Women's Cardiovascular Health YR 2016 FD 2016 PB McGraw-Hill Education PP New York, NY SN 9780071786201 LK accesscardiology.mhmedical.com/content.aspx?aid=1128087933 RD 2024/03/28 AB A 31-year-old woman was admitted in a state of cardiogenic shock 6 months after she was diagnosed with nonischemic cardiomyopathy. Nearly 9 to 12 months ago, she had started experiencing fatigue and dyspnea while climbing stairs and was diagnosed with left ventricular systolic dysfunction a few months later. She had ejection fraction of 15% and dilated left ventricle of 6.8 cm and was started on medicines and evidence-based treatment. More recently, she developed intolerance toward her current carvedilol dose that had to be reduced as it caused hypotension and nausea. Currently, the patient was admitted with blood pressure of 88/62 mm Hg, heart rate of 105 beats per minute, S3 gallop on examination, elevated jugular venous distention to 6 cm above the clavicle, cool extremities, brain natriuretic peptide of 953 pg/mL, serum sodium of 134 mmol/L, and total bilirubin of 4 mg/dL. The physician started her on an inotrope upon admission. After diuresis, her right heart catheterization revealed elevated filling pressures (right atrial pressure of 15 mm Hg, wedge pressure of 36 mm Hg), pulmonary hypertension (mean pulmonary artery pressure of 49 mm Hg), and low cardiac index <1.8 on dobutamine 5 μg/kg/min. Echo now revealed progression of left ventricular dilation to 7.2 cm, moderate mitral regurgitation, and moderate right ventricular dysfunction in addition to left-sided failure. Due to advanced stage of the disease and clinical decline in patient's condition, she was worked up for cardiac transplantation and listed with blood type O. Meanwhile, she continued to decline requiring 2 inotropes, and a repeat hemodynamic evaluation showed a high pulmonary vascular resistance of 4.5 Wood units. Her chances of receiving a cardiac transplant were also limited by both her blood type (type O) and worsening pulmonary hypertension. Besides, she could not tolerate attempts to wean her off the inotrope or pressor support, and continued to become more tachycardic. So a decision was made to implant ventricular assist device that would act as a bridge to cardiac transplantation by extending the life of the patient.