Recovery from neonatal myocardial dysfunction after treatment of acute hypertension.

Abstract

Over the next 48 hours, her systolic blood pressure increased from 85 to 120 mm Hg. She developed increasing heart failure with liver enlargement up to 5 cm below the right costal margin, poor perfusion, and falling urine output. Electrocarand University of Alberta Hospitals, Edmonton, diography showed ST and T wave changes consistent with ischaemia. Echocardiography at 6 days of age showed left atrial and left ventricular enlargement but no structural abnormality. Left ventricular shortening fraction was only 10%. Cardiac catheterisation confirmed poor left ventricular function with generalised hypokenesis of the left ventricle. The origin of the left coronary artery was normal. On repeat ultrasound scanning the right

Presentation and Echocardiographic Markers of Neonatal Hypertensive Cardiomyopathy

“…7 Correction of hypertension (either pharmacologically or through nephrectomy) led to improvement or resolution in the case studies reviewed. [8][9][10] Numerous case reports of systemic neonatal hypertension discuss echocardiographic findings. Typically, poor right ventricular and/or LV function is reported, specifically poor systolic function (decreased LV shortening fraction).…”

“…Some studies report concentric LVH with a thickened intraventricular septum; others report dilated cardiomyopathy. [6][7][8][9][10] Other causes of myocardial dysfunction in neonates include myocarditis, coronary anomalies, aortic valve disease, and coarctation of the aorta. Of the aforementioned causes, only coarctation has been associated with hypertension; the remaining causes are associated with hypotension.…”

Renovascular Hypertension in Infant Presenting With Cardiogenic Shock

“…3 In our patient, echocardiographic signs of left ventricular dysfunction and electrocardiographic signs of abnormal repolarization persisted several weeks after blood pressure control. This indicates myocardial changes that developed as a result of chronic pressure overload.…”

“…[1][2][3][4] This is caused by a very limited myocardial contractile reserve in response to increased afterload in neonatal age. The heart responds to pressure overload with hypertrophy and increased wall thickness; nevertheless, the pressure overload impairs contractile function of isolated myocytes and papillary muscles.…”

“…The heart responds to pressure overload with hypertrophy and increased wall thickness; nevertheless, the pressure overload impairs contractile function of isolated myocytes and papillary muscles. [3][4][5] Hypertensive crises require immediate therapy to decrease associated morbidity and mortality 6 and a thorough diagnostic workup to reach a specific diagnosis. Renal ultrasound is a useful initial screening examination, allowing to narrow the differential diagnosis.…”