title: [An elderly man with known heart failure admitted with cardiogenic shock].
abstract: A 75-year-old man with post-MI heart failure and an ejection fraction of 15 % was treated with an ACE-inhibitor, spironolactone and a beta-blocker. He had reduced his intake of food and water due to an intercurrent illness the days before admission. He was admitted to our coronary care unit due to bradycardia and hypotension. On arrival his blood pressure was 60/40 mm Hg, and he was in a cardiogenic shock. The electrocardiogram showed broad QRS-complexes and large T waves. Serum-potassium was 9.1 mmol/L and he had acute renal failure with oliguria, probably caused by reduced cardiac output due to hypovolemia combined with taking an ACE inhibitor and spironolactone. Haemodialysis was started and during dialysis QRS complexes became more narrow and heart rate and blood pressure normalized. The patient was discharged 10 days later with normal potassium and creatinine levels. Patients treated with ACE-inhibitors and spironolactone should be monitored closely. During intercurrent illness dehydration may occur and this can lead to renal failure and hyperkalemia which can be life-threatening. The condition should be recognized and addressed promptly, and if indicated haemodialysis should be performed.
authors.affiliation: Avdeling Hjerte, Medisinsk klinikk, Nordlandssykehuset, Bodø, Norway. anders.w.hovland@gmail.com
authors.forename: Anders
authors.initials: A
authors.lastname: Hovland
authors.forename: Anne Kristine
authors.initials: AK
authors.lastname: Fagerheim
authors.forename: Randolf
authors.initials: R
authors.lastname: Hardersen
authors.forename: Erik Waage
authors.initials: EW
authors.lastname: Nielsen
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000628:therapy; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D003937:Diagnosis, Differential; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D010343:Patient Admission; D006435:Renal Dialysis; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000209:etiology*; D013148:Spironolactone / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone