title: Unmasking of neonatal renovascular hypertension by milrinone used for cardiac dysfunction.
abstract: A neonate initially presented with heart failure, with severe cardiac dysfunction confirmed by echocardiography, at 3 days of age. Blood pressure at presentation was in the high normal range. It was not until there was a rapid improvement of left-ventricular function on intravenous milrinone that the infant was noted to be hypertensive on day of life 7. It is noteworthy that milrinone, a drug with vasodilator and inotropic properties, paradoxically unmasked hypertension by rapidly improving left-ventricular function. Subsequent work-up showed the etiology of hypertension to be left renal artery stenosis. We present this case to alert clinicians to the rarer causes of left-ventricular dysfunction and to point out that its etiology, i.e., hypertension, may not be apparent until there is improvement in the systolic function of the left ventricle.
authors.affiliation: Division of Pediatric Cardiology, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, USA. pramaswamy@maimonidesmed.org
authors.forename: Prema
authors.initials: P
authors.lastname: Ramaswamy
authors.forename: Susan
authors.initials: S
authors.lastname: Schulman
authors.forename: Panayot
authors.initials: P
authors.lastname: Filipov
authors.forename: Juan C
authors.initials: JC
authors.lastname: Kupferman
mesh_terms: D000792:Angiography; D001794:Blood Pressure / Q000187:drug effects; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000151:congenital / Q000175:diagnosis / Q000188:drug therapy*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D020105:Milrinone / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D020105:Milrinone