Cargando…

Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Louw, Jacoba, Brown, Stephen, Eyskens, Benedicte, Heying, Ruth, Cools, Bjorn, Gewillig, Marc, Thewissen, Liesbeth, Allegaert, Karel, Smits, Anne, Levtchenko, Elena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Clinics Cardive Publishing 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721817/
https://www.ncbi.nlm.nih.gov/pubmed/23736130
http://dx.doi.org/10.5830/CVJA-2013-003
_version_ 1782278092469829632
author Louw, Jacoba
Brown, Stephen
Eyskens, Benedicte
Heying, Ruth
Cools, Bjorn
Gewillig, Marc
Thewissen, Liesbeth
Allegaert, Karel
Smits, Anne
Levtchenko, Elena
author_facet Louw, Jacoba
Brown, Stephen
Eyskens, Benedicte
Heying, Ruth
Cools, Bjorn
Gewillig, Marc
Thewissen, Liesbeth
Allegaert, Karel
Smits, Anne
Levtchenko, Elena
author_sort Louw, Jacoba
collection PubMed
description 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. CONCLUSION: 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.
format Online
Article
Text
id pubmed-3721817
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Clinics Cardive Publishing
record_format MEDLINE/PubMed
spelling pubmed-37218172013-08-07 Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues Louw, Jacoba Brown, Stephen Eyskens, Benedicte Heying, Ruth Cools, Bjorn Gewillig, Marc Thewissen, Liesbeth Allegaert, Karel Smits, Anne Levtchenko, Elena Cardiovasc J Afr Cardiovascular Topics 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. CONCLUSION: 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. Clinics Cardive Publishing 2013-04 /pmc/articles/PMC3721817/ /pubmed/23736130 http://dx.doi.org/10.5830/CVJA-2013-003 Text en Copyright © 2010 Clinics Cardive Publishing http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Cardiovascular Topics
Louw, Jacoba
Brown, Stephen
Eyskens, Benedicte
Heying, Ruth
Cools, Bjorn
Gewillig, Marc
Thewissen, Liesbeth
Allegaert, Karel
Smits, Anne
Levtchenko, Elena
Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues
title Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues
title_full Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues
title_fullStr Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues
title_full_unstemmed Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues
title_short Neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues
title_sort neonatal circulatory failure due to acute hypertensive crisis: clinical and echocardiographic clues
topic Cardiovascular Topics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721817/
https://www.ncbi.nlm.nih.gov/pubmed/23736130
http://dx.doi.org/10.5830/CVJA-2013-003
work_keys_str_mv AT louwjacoba neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT brownstephen neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT eyskensbenedicte neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT heyingruth neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT coolsbjorn neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT gewilligmarc neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT thewissenliesbeth neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT allegaertkarel neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT smitsanne neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues
AT levtchenkoelena neonatalcirculatoryfailureduetoacutehypertensivecrisisclinicalandechocardiographicclues