title: [Unusual cause of right heart failure decompensation in 21-years old patient with idiopathic pulmonary arterial hypertension -- a case report].
abstract: The authors describe a case of 21-years old woman with idiopathic pulmonary arterial hypertension with atypical clinical consequences of massive internal bleeding. Despite significant hypovolemia clinical and laboratory presentation was one of RV failure with dilatation of right heart ventricle and increased plasma level of markers of myocardial stretch and injury (NT-proBNP and troponin, respectively). This is attributed to impaired right ventricular coronary perfusion and hypoxia. Intensive treatment restored baseline RV conditions and at 15 months follow-up no persistent right heart impairment was observed. This case demonstrates that bleeding should be also considered in differential diagnosis of exacerbation of right ventricular failure in patients with pulmonary arterial hypertension.
authors.affiliation: Klinika Chorób Wewnetrznych Klatki Piersiowej, Instytut Gruźlicy i Chorób Płuc w Warszawie. michal_florczyk@poczta.wp.pl
authors.forename: Michał
authors.initials: M
authors.lastname: Florczyk
authors.forename: Anna
authors.initials: A
authors.lastname: Stawecka-Pawełczyk
authors.forename: Marcin
authors.initials: M
authors.lastname: Kurzyna
authors.forename: Anna
authors.initials: A
authors.lastname: Fijałkowska
authors.forename: Janusz
authors.initials: J
authors.lastname: Burakowska
authors.forename: Joanna
authors.initials: J
authors.lastname: Zyłkowska
authors.forename: Monika
authors.initials: M
authors.lastname: Szturmowicz
authors.forename: Liliana
authors.initials: L
authors.lastname: Wawrzyńska
authors.forename: Witold
authors.initials: W
authors.lastname: Tomkowski
authors.forename: Adam
authors.initials: A
authors.lastname: Torbicki
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D017380:Hypertrophy, Right Ventricular / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D020107:Troponin T / Q000097:blood; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000175:diagnosis / Q000209:etiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain