Abstract| Volume 23, ISSUE 10, SUPPLEMENT , S33, October 2017

A Case of Advanced Heart Failure with Severe Systolic Dysfunction Deteriorated with Right Heart Failure

      Case: The patient was a 28-year-old female with dilated cardiomyopathy and Emery-Dreifuss muscular dystrophy. She had admitted to our hospital 21 months prior with acute decompensated heart failure and standard therapy for heart failure including CRT-D had been introduced, however thereafter, her left ventricular ejection fraction had been around 20%. She had frequently admitted with acute renal failure caused by diarrhea and mild dehydration. This time, she appeared with increased level of creatinine and increased body weight and ascites. Dobutamine, intravenous furosemide, extracorporeal ultrafiltration method (ECUM), and cessation of ACE inhibitor were effective to increase urine volume and to decrease ascites, respectively and transiently. However, once after transaminase started to increase, body weight and ascites restarted to increase. Subsequently, central venous pressure increased and became ECUM-dependent and a left ventricular assist device was introduced. Conclusion: In treatment of patients with advanced heart failure with severe systolic dysfunction, right heart failure is critical.
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