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CASE REPORT
Year : 2019  |  Volume : 9  |  Issue : 2  |  Page : 111-115

Isolated acute right heart failure syndrome in a young male with severe sepsis: An unusual pathophysiology in a normal heart


Department of Cardiology, Aayush Hospitals, Vijayawada, Andhra Pradesh, India

Correspondence Address:
Dr. Raghuram Palaparti
Aayush Hospitals, Ramachandra Nagar, Vijayawada - 520 008, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JICC.JICC_28_19

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Acute right heart failure is being increasingly recognized in intensive care unit (ICU) and when severe, can contribute to hemodynamic instability. Sepsis-induced myocardial dysfunction is also a known entity in critical care ICU. However, isolated right ventricle (RV) dysfunction in patients with sepsis after excluding chronic heart and lung disease is underdiagnosed and reported uncommonly. Whether RV is a bystander or a major contributor to hemodynamic instability in that scenario has not been studied clearly. Here, we report a 42-year-old male patient with no major cardiovascular risk factors who presented to us in shock with a history of low-grade fever, generalized weakness, and decreased urine output for 3 days. On physical examination, he had pedal edema and neck vein distension. He was found to have neutrophilic leukocytosis, deranged renal function test, and liver function test. His chest X-ray posteroanterior view showed cardiomegaly with pulmonary congestion. His electrocardiography (ECG) showed right bundle branch block (RBBB). He was anuric and started on dialysis for severe acidosis. In view of shock, renal failure and RBBB on ECG, a transthoracic echocardiography was done which showed gross dilatation of right atrium, and RV with severe RV dysfunction with normal left ventricle function. Contrast-enhanced computerized tomography chest was negative for pulmonary thromboembolism. His blood culture has grown Escherichia coli. With intravascular (IV) fluids, ionotropic support, renal replacement therapy, IV antibiotics, and other supportive therapy, he gradually improved. His serial ECGs showed resolution of RBBB. Two-dimensional echo showed improved RV function. He was discharged on day 9 and his 2-week follow-up echo showed normalization of RV function. During follow-up, his coronary angiogram showed normal coronaries. This case illustrates the importance of identifying acute RV failure in patients with severe sepsis with shock. It also underscores the necessity for more studies and research on understanding the pathophysiology of RV dysfunction in critical care patients and its contribution to hemodynamic instability.


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