23 yo F with chest pain and hypotension

Case originally by Eric Tanenbaum, MD. Posted and edited by Brandon Fainstad, MD and Yilin Zhang, MD. 


CASE:

23 year old woman with severe pulmonary hypertension presents with 3 days of worsening chest pain, shortness of breath and decreased urine output. She ran out of her sildenafil and torsemide 5 days ago. She feels light headed when standing up, shortness of breath is no worse when lying flat, denies leg swelling or weight changes.  HR 115bpm, BP 82/40, distended neck veins, clear lungs to auscultation and 2+ LE edema.

Parasternal Long Axis (PSLA)

Parasternal Short Axis (PSSA)

What is your interpretation of her echo images?


Why is this exam so valuable in determining the appropriate management of this patient?


OUTCOME:

The patient was given IV torsemide and their home sildenafil.  She diuresed 1L overnight and her blood pressure improved to 90/50.  She was discharged 3 days later with a stable blood pressure and a return to her symptomatic baseline after diuresing a total of 5L.