Pulmonary Artery Rupture From Invasive Hemodynamic Monitoring

Abstract

A72-YEAR-OLD MAN WITH SYSTOLIC HEART failure (left ventricular ejection fraction, 20%) and hypertension was admitted to the hospital with 2 weeks of dyspnea at rest and a 20-lb weight gain. He reported good compliance with his outpatient regimen of lisinopril, carvedilol, spironolactone, and furosemide. Findingsfromphysicalexaminationwerenotableforablood pressure of 95/40 mm Hg and heart rate of 105 beats/ min, elevated jugular venous pressure, diffuse crackles in the lung fields, an S3 gallop, and warm extremities. The patient was admitted to the cardiac intensive care unitandadministeredintravenousfurosemide,withanet diuresis of 2 L overnight. Thenexthospitalday,thepatient’screatininelevelhad increasedfrom0.8to1.4mg/dL,buthisdyspneahadimproved. He had persistent crackles bilaterally and an S3 galloponauscultation.Concernforworseningrenalfunction prompted right heart catheterization for continuoushemodynamicmonitoring.Apulmonaryarterycatheterwasplacedintheintensivecareunitusingultrasound guidancethroughtherightinternaljugularvein.Theprocedure was uncomplicated and confirmed elevated left and right heart filling pressures. Diuresis was continued; isosorbide and hydralazine therapies were added to decrease his systemic vascular resistance.