Hypertrophic osteoarthropathy caused by PGE1 in a patient with congestive heart failure during cardiac rehabilitation.
Continuous chronic drug infusion with PGE1 via a portable pump and neuromuscular electrical stimulation (NMES) help to improve the quality of life in patients with severe chronic heart failure waiting for a donor heart, as both treatments can be performed at home. We report a 56-year-old woman suffering from severe chronic heart failure, who was referred for a cardiac rehabilitation program because of progressive muscle weakness and weight loss. Due to her underlying heart disease she was unable to perform voluntary exercise. NMES of both knee extensor muscles was started. Under simultaneous chronic drug infusion with PGE1 via a portable pump the patient developed clinical signs of hypertrophic osteoarthropathy, which prevented her from continuing the rehabilitation program. X-ray examinations and bone scans concurred with the diagnosis of secondary hypertrophic osteoarthropathy. After the PGE1 dose had been reduced, the clinical signs of the osteoarthropathy resolved and the patient was able to continue the rehabilitation program with no difficulty. This case report underlines the importance of being aware of the potential side effects of modern cardiac drugs in the complex treatment of patients waiting for a donor heart.
Crevenna
Richard
R
Department of Physical Medicine and Rehabilitation, General Hospital Vienna, University of Vienna, Austria. richard.crevenna@univie.ac.at
Quittan
Michael
M
Hülsmann
Martin
M
Wiesinger
Günther F
GF
Keilani
Mohammad Y
MY
Kainberger
Franz
F
Leitha
Thomas
T
Fialka-Moser
Veronika
V
Pacher
Richard
R
D000527:Alprostadil / Q000008:administration & dosage / Q000009:adverse effects*; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000187:drug effects; D002908:Chronic Disease; D003131:Combined Modality Therapy; D005260:Female; D006333:Heart Failure / Q000534:rehabilitation*; D016027:Heart Transplantation; D006801:Humans; D007260:Infusion Pumps; D008875:Middle Aged; D018908:Muscle Weakness / Q000534:rehabilitation; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D004561:Transcutaneous Electric Nerve Stimulation; D014850:Waiting Lists
D000527:Alprostadil