Reactions 1309 - 10 Jul 2010

STerlipressin

Cardiovascular disorders and peripheralischaemia: case report

A 52-year-old man developed cardiovascular disorders,including supraventricular tachycardia, myocardialinfarction, myocardial dysfunction and cardiogenic shock,as well as peripheral ischaemia, after receiving terlipressinfor upper GI bleeding.

The man presented to an emergency department withupper GI bleeding and received an IV terlipressin bolus of 4mg followed by 2 mg every 6 hours for 2 days. A few hoursafter terlipressin was started, he developed palpitation andsupraventricular tachycardia was discovered.

The man received three IV boluses of adenosine, and histachycardia responded. On the second day, he went intoacute pulmonary oedema and shock. He receivedmechanical ventilation, dopamine and norepinephrine[noradrenaline], and terlipressin was discontinued. An ECGrevealed elevated serial cardiac markers and anechocardiogram showed diffuse global left and rightventricular hypokinesia, right ventricle enlargement, severeleft ventricle dysfunction (ejection fraction 18%), and rightventricular systolic pressure of 32 mm Hg. On day 3 ofhospitalisation, he developed signs of peripheral ischaemiain his limbs. The ischaemia progressed to gangrene of thedistal phalanges of his fingers and all his toes. Three dayslater, he improved; mechanical ventilation and inotropicsupport were stopped. Two weeks later, anechocardiogram revealed normalisation of his ventricularfunction (ejection fraction 52%).Elzouki A-N, et al. Terlipressin-induced severe left and right ventriculardysfunction in patient presented with upper gastrointestinal bleeding: case reportand literature review. American Journal of Emergency Medicine 28:540.e1-540.e6, No. 4, May 2010. Available from: URL: http://dx.doi.org/10.1016/j.ajem.2009.08.012 - Qatar 803023830

1

Reactions 10 Jul 2010 No. 13090114-9954/10/1309-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved