title: A case of severe hypoalbuminemia associated with chronic congestive heart failure: the role of the tricuspid regurgitation.
abstract: Hypoalbuminemia is considered an independent predictor of mortality, especially in elderly patients. It is common in patients with congestive heart failure, when is due to several mechanisms: increased volume of distribution, significant stasis in the mesenteric circulation and altered protein metabolism in the liver. These alterations are even more pregnant when tricuspid regurgitation is associated or aggravated by different risk factors (recent infections, anemia, hyperthyroidism). We present the case of an elderly patient with severe hypoproteinemia and important hypoalbuminemia associated with congestive heart failure and aggravation of tricuspid regurgitation. The differential diagnosis concluded that hypoalbuminemia was influenced by tricuspid regurgitation as it enhanced liver dysfunction and enteral protein absorption due to increased stasis in mesenteric system. On the other hand, hypoalbuminemia contributed to the progression of heart failure by favoring myocardial edema, volume overload, and diuretic resistance. This is why correct management of this situation should include removal of subclinical excess of fluid and renutrition. A multidisciplinary approach is needed in order to achieve a good control of the symptoms and a significant improvement of quality of life.
authors.forename: Ioana Dana
authors.initials: ID
authors.lastname: Alexa
authors.forename: Adina Carmen
authors.initials: AC
authors.lastname: Ilie
authors.forename: Anca
authors.initials: A
authors.lastname: Moroşanu
authors.forename: Irina
authors.initials: I
authors.lastname: Crăcană
authors.forename: Ramona
authors.initials: R
authors.lastname: Onuţu
authors.forename: Ana
authors.initials: A
authors.lastname: Voica
mesh_terms: D000369:Aged, 80 and over; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications* / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010348:Patient Care Team; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000628:therapy