title: Left ventricular assist device hemolysis leading to dysphagia.
abstract: A 41-year-old man with a continuous-flow left ventricular assist device presented for evaluation of dysphagia and dark urine. He was found to have a significantly elevated L-lactate dehydrogenase and an elevated plasma free hemoglobin consistent with intravascular hemolysis. After the hemolysis ceased, both the black urine and dysphagia resolved spontaneously. Transient esophageal dysfunction, as a manifestation of gastrointestinal dysmotility, is known to occur in the setting of hemolysis. Paroxysmal nocturnal hemoglobinuria is another recognized cause of massive hemolysis with gastrointestinal dysmotility occurring in 25%-35% of patients during a paroxysm. Intravascular hemolysis increases plasma free hemoglobin, which scavenges nitric oxide (NO), an important second messenger for smooth muscle cell relaxation. The decrease in NO can lead to esophageal spasm and resultant dysphagia. In our patient the resolution of hemolysis resulted in resolution of dysphagia.
authors.affiliation: Alexander Wuschek, Sara Iqbal, Jerry Estep, Eamonn Quigley, David Richards, Department of Medicine, Division of Gastroenterology, Houston Methodist Hospital, Houston, TX 77030, United States.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wuschek
authors.affiliation: Alexander Wuschek, Sara Iqbal, Jerry Estep, Eamonn Quigley, David Richards, Department of Medicine, Division of Gastroenterology, Houston Methodist Hospital, Houston, TX 77030, United States.
authors.forename: Sara
authors.initials: S
authors.lastname: Iqbal
authors.affiliation: Alexander Wuschek, Sara Iqbal, Jerry Estep, Eamonn Quigley, David Richards, Department of Medicine, Division of Gastroenterology, Houston Methodist Hospital, Houston, TX 77030, United States.
authors.forename: Jerry
authors.initials: J
authors.lastname: Estep
authors.affiliation: Alexander Wuschek, Sara Iqbal, Jerry Estep, Eamonn Quigley, David Richards, Department of Medicine, Division of Gastroenterology, Houston Methodist Hospital, Houston, TX 77030, United States.
authors.forename: Eamonn
authors.initials: E
authors.lastname: Quigley
authors.affiliation: Alexander Wuschek, Sara Iqbal, Jerry Estep, Eamonn Quigley, David Richards, Department of Medicine, Division of Gastroenterology, Houston Methodist Hospital, Houston, TX 77030, United States.
authors.forename: David
authors.initials: D
authors.lastname: Richards
mesh_terms: D000328:Adult; D001037:Aphasia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003679:Deglutition; D004945:Esophagoscopy; D004947:Esophagus / Q000378:metabolism / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006454:Hemoglobins / Q000378:metabolism; D006461:Hemolysis; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D011474:Prosthesis Design; D012307:Risk Factors; D016277:Ventricular Function, Left
chemical_list: D006454:Hemoglobins; D009569:Nitric Oxide
keywords: Esophageal spasm; Hemolysis; Left ventricular assist device; Nitric oxide; dysphagia