OUTCOME AND FOLLOW-UP
As shown in Figure 2, administration of dobutamine and pimobendane in addition to azosemide and tolvaptan resulted in good diuresis initially, which gradually deteriorated and the patient’s HR showed an elevation to 120 /min. The subsequent administration of eplerenone and enalapril to manage residual pleural effusion resulted in hemodynamic deterioration with low systolic pressure (approximately 80 mmHg). Transthoracic echocardiographic examination revealed low stroke volume (SV) and an extreme overlap between the E- and A-waves (Figure 3-left). Administration of oral ivabradine (5 mg twice daily) improved tachycardia and decreased the overlap; the velocity-time integral at the left ventricular outflow tract (LVOT-VTI), SV, and blood pressure increased (Figure 2, and Figure 3-right). His hemodynamics stabilized subsequently, and the pulmonary congestion disappeared, allowing the patient to be weaned from catecholamines. Eventually the LVEF increased to 32.0% (Figure 4), HF improved, and he was discharged on the 60th day.
This case report has been published with the prior consent of the patient.