OUTCOME AND FOLLOW-UP
As shown in Figure 2,
administration of dobutamine and
pimobendane in addition to azosemide and tolvaptan resulted in good
diuresis initially, which gradually deteriorated and the patient’s HR
showed an elevation to 120 /min. The subsequent administration of
eplerenone and enalapril to manage residual pleural effusion resulted in
hemodynamic deterioration with low systolic pressure (approximately 80
mmHg). Transthoracic echocardiographic examination revealed low stroke
volume (SV) and an extreme overlap between the E- and A-waves (Figure
3-left). Administration of oral ivabradine (5 mg twice daily) improved
tachycardia and decreased the overlap; the velocity-time integral at the
left ventricular outflow tract (LVOT-VTI), SV, and blood pressure
increased (Figure 2, and Figure 3-right). His hemodynamics stabilized
subsequently, and the pulmonary congestion disappeared, allowing the
patient to be weaned from catecholamines. Eventually the LVEF increased
to 32.0% (Figure 4), HF improved, and he was discharged on the 60th
day.
This case report has been published with the prior consent of the
patient.