A comparison of nesiritide vs. epoprostenol in a patient with precapillary pulmonary hypertension due to scleroderma complicated by postcapillary pulmonary hypertension.
To the best of our knowledge, acute decompensated left-sided heart failure with preserved left ventricular ejection fraction in a patient with scleroderma has not been previously reported. We describe a patient with severe pulmonary hypertension due to limited scleroderma in whom nesiritide led to marked reductions in pulmonary arterial and capillary wedge pressure as well as resolution of symptoms and pulmonary edema. Subsequent epoprostenol use was associated with an increase in pulmonary capillary wedge pressure and a recurrence of pulmonary edema. Thus, nesiritide may be the preferred agent in scleroderma patients with severe pulmonary hypertension and preserved left ventricular systolic function since epoprostenol may lead to adverse hemodynamic effects.
Zakir
Ramzan M
RM
Department of Medicine, Hackensack University Medical Center, Hackensack, NJ 07601, USA.
Berkowitz
Robert L
RL
Saric
Muhamed
M
Ashtyani
Hormoz
H
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D017548:Echocardiography, Transesophageal; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D011654:Pulmonary Edema / Q000517:prevention & control; D011669:Pulmonary Wedge Pressure; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D020097:Natriuretic Peptide, Brain; D011464:Epoprostenol