title: Hypertrophic osteoarthropathy caused by PGE1 in a patient with congestive heart failure during cardiac rehabilitation.
abstract: 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.
authors.affiliation: Department of Physical Medicine and Rehabilitation, General Hospital Vienna, University of Vienna, Austria. richard.crevenna@univie.ac.at
authors.forename: Richard
authors.initials: R
authors.lastname: Crevenna
authors.forename: Michael
authors.initials: M
authors.lastname: Quittan
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
authors.forename: Günther F
authors.initials: GF
authors.lastname: Wiesinger
authors.forename: Mohammad Y
authors.initials: MY
authors.lastname: Keilani
authors.forename: Franz
authors.initials: F
authors.lastname: Kainberger
authors.forename: Thomas
authors.initials: T
authors.lastname: Leitha
authors.forename: Veronika
authors.initials: V
authors.lastname: Fialka-Moser
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
mesh_terms: 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
chemical_list: D000527:Alprostadil