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Int J Angiol
DOI: 10.1055/s-0043-1761271
Case Report

Ambulatory Care Management in Low Blood Pressure Patient with HFrEF

Fajar H. Panjaitan
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Dian Yaniarti Hasanah 
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Emir Yonas 
2   Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
,
Rarsari Soerarso 
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
› Author Affiliations Funding None.
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Abstract

Heart failure (HF) affects an estimated 38 million people globally, with most published research estimating a prevalence of 1 to 2% of the adult population. Low blood pressure (BP) is reported in 10 to 15% of patients with HF in clinical trials, although this proportion is much more frequent in routine clinical practice. Low BP in outpatients has a better outcome compared to inpatients. Low BP is often a restricting factor in the use and uptitration of guideline-directed medical therapy (GDMT).

A 57-year-old male presented himself to the HF clinic with complaints of bloating, shortness of breath, and fatigue. The patient had a history of acute coronary syndrome and cardiac arrest, but the results of coronary angiography showed nonsignificant coronary artery disease. Cardiomegaly was seen on chest X-ray. Electrocardiogram showed pathologic q wave II, III, and AvF with poor r wave progression on V1-V6. The patient was admitted due to acute decompensated HF with hypotension. After the initial decongestion patient was treated with sacubitril/valsartan, bisoprolol, and spironolactone in the outpatient clinic. Patient complaints and BP slowly improved during the outpatient phase.

Hypotension remains a challenge in implementing GDMT in HF patients. By following the steps according to algorithm and current guidelines, GDMT can be optimized in these patients.

Keywords

heart failure with reduced ejection fraction - low blood pressure - ambulatory patient


Publication History

Article published online:
08 February 2023

© 2023. International College of Angiology. This article is published by Thieme.

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