Very Complicated Case of Acute Heart Failure with Background of Intracranial Tumor

We report a very complicated case of acute heart failure with background of intracranial tumor. A 17-year-old female was brought to our emergency department due to adrenal crisis. She was diagnosed secondary panhypopituitarism and central diabetes inspidus (DI) caused by intracranial tumor. Although an appropriate hormone and fluid replacement therapy helped to normalize her blood pressure, her respiratory status drastically deteriorated. A severe generalized edema and bilateral pleural effusions developed and the laboratory data showed prominent elevation of serum BNP. Based on the diagnosis of acute heart failure, the patient admitted to the intensive care unit. The venous furosemide administration and the use of non-invasive ventilation reduced her excessive fluid. The left ventricular ejection fraction (LVEF) rather reduced down to 20% and simultaneously acute renal failure developed. Therefore, we decided to start monitoring with Swan-Ganz catheter and it revealed mean PCWP of 28 mmHg and cardiac index of 2.1L/min/m2. The administration of dobutamine and carperitide, and temporary hemodialysis gradually improved her hemodynamics and LVEF day by day. In this case, mechanism of deterioration of LVEF should be discussed and the continuous existence of hypernatremia made the pathophysiology more complicated, because the endocrinologists still suspected dehydration due to DI. However, the early employment of Swan-Ganz catheter monitoring elucidated the details of her hemodynamics and helped to manage the heart failure appropriately.