title: [70-year-old woman with cardiac hypertrophy and severe pulmonary hypertension: pre- or postcapillary?].
abstract: METHODS
  A 70-year-old female patient was admitted with progressive dyspnea and peripheral edema. The patient had a medical history of myocardial hypertrophy, diastolic dysfunction and concomitant pulmonary hypertension (PH).
  
  
  METHODS
  The physical exam was suggestive of cardiac decompensation. Echocardiography showed myocardial hypertrophy, an enlarged left atrium as well as enlarged right-sided heart chambers. A prominent tricuspid regurgitation jet was present, and the estimated systolic right ventricular pressure was 65 mmHg. Invasive hemodynamic measurements showed a marked pressure elevation in the pulmonary circulation (mean PAP 51 mmHg), combined with an elevated left ventricular end-diastolic pressure (LVEDP) of 30 mmHg and a profound increase in the transpulmonary gradient (TPG, 21 mmHg).
  
  
  METHODS
  The synopsis of these findings led to the diagnosis of postcapillary PH with a prominent precapillary involvement and cardiac decompensation. Due to signs of volume overload, an adequate diuretic therapy was initiated. The patient was recompensated and lost 7 kg of weight, which was associated with substantial clinical improvement. At invasive follow-up hemodynamic measurement, the patient's PAP was substantially decreased and almost reached normal values. The previously diagnosed precapillary involvement had disappeared.
  
  
  CONCLUSIONS
  PH is a frequent phenomenon in patients with systolic and diastolic heart failure, and might initially appear as a combination of pre- and postcapillary involvement. The patients' volume status has a major influence on pulmonary hemodynamics. An adequate therapy of the underlying heart failure, especially an adequate diuresis, may have marked beneficial effects on pulmonary hemodynamics. Hemodynamic measurements should always be performed in compensated status.
authors.affiliation: Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln
authors.forename: D
authors.initials: D
authors.lastname: Dumitrescu
authors.forename: F
authors.initials: F
authors.lastname: Gerhardt
authors.forename: T
authors.initials: T
authors.lastname: Viethen
authors.forename: E
authors.initials: E
authors.lastname: Erdmann
authors.forename: S
authors.initials: S
authors.lastname: Rosenkranz
mesh_terms: D000368:Aged; D001810:Blood Volume / Q000187:drug effects; D006328:Cardiac Catheterization; D006332:Cardiomegaly / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D004232:Diuretics / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology*; D004452:Echocardiography; D004489:Edema, Cardiac / Q000209:etiology*; D005260:Female; D054144:Heart Failure, Diastolic / Q000175:diagnosis / Q000188:drug therapy; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D011669:Pulmonary Wedge Pressure / Q000187:drug effects / Q000502:physiology; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000188:drug therapy; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D004232:Diuretics