title: Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues.
abstract: OBJECTIVE
  Circulatory failure due to acute arterial hypertension in the neonatal period is rare. This study was undertaken to assess the clinical and echocardiographic manifestations of circulatory failure resulting from acute neonatal hypertensive crisis.
  
  
  METHODS
  Neonatal and cardiology databases from 2007 to 2010 were reviewed. An established diagnosis of circulatory failure due to neonatal hypertension before the age of 14 days was required for inclusion. Six patients were identified.
  
  
  RESULTS
  Five patients presented with circulatory failure due to an acute hypertensive crisis. The median age at presentation was 8.5 days (range: 6.0-11.0) with a median body weight of 3.58 kg (range: 0.86-4.70). Echocardiography demonstrated mild left ventricular dysfunction [median shortening fraction (SF) 25%, range 10-30] and mild aortic regurgitation in 83% (5/6) of patients. One patient with left ventricular dysfunction (SF = 17%) had a large apical thrombus. Two patients were hypotensive, and hypertension only became evident after restoration of cardiac output. Administration of intravenous milrinone was successful, with rapid improvement of the clinical condition. Left ventricular function normalised in all survivors.
  
  
  CONCLUSIONS
  Early neonatal circulatory collapse due to arterial hypertension is a rare but potentially life-threatening condition. At presentation, hypotension, especially in the presence of a dysfunctional left ventricle, does not exclude a hypertensive crisis being the cause of circulatory failure. The echocardiographic presence of mild aortic regurgitation combined with left ventricular hypocontractility in a structurally normal heart should alert the physician to the presence of underlying hypertension.
authors.affiliation: Paediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Jacoba
authors.initials: J
authors.lastname: Louw
authors.forename: Stephen
authors.initials: S
authors.lastname: Brown
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Thewissen
authors.forename: Anne
authors.initials: A
authors.lastname: Smits
authors.forename: Benedicte
authors.initials: B
authors.lastname: Eyskens
authors.forename: Ruth
authors.initials: R
authors.lastname: Heying
authors.forename: Bjorn
authors.initials: B
authors.lastname: Cools
authors.forename: Elena
authors.initials: E
authors.lastname: Levtchenko
authors.forename: Karel
authors.initials: K
authors.lastname: Allegaert
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
mesh_terms: D000208:Acute Disease; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D062186:Arterial Pressure / Q000187:drug effects; D001835:Body Weight; D002316:Cardiotonic Agents / Q000627:therapeutic use; D018618:Echocardiography, Doppler, Color; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D007022:Hypotension / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D007228:Infant Nutrition Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D007231:Infant, Newborn; D020105:Milrinone / Q000627:therapeutic use; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D012769:Shock / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D020105:Milrinone