Sorafenib-Associated Heart Failure Complicated by Cardiogenic Shock after Treatment of Advanced Stage Hepatocellular Carcinoma: A Clinical Case Discussion
Table 3
(a) The clinical exam and hemodynamic profile consistent with low output heart failure prior to treatment with dobutamine infusion. (b) The clinical exam and hemodynamic profile after treatment with dobutamine infusion.
(a)
Physical exam
Vital signs MAP 59–62 mmHg, HR 92 bpm, RR 20/min
Right heart catheterization
Measurements
General
Wrapped in blankets including head. Appears fatigued.
RA mean pressure
8 mmHg
Head, neck, throat
Dry mucous membranes.
RV pressure
33/9 mmHg
Cardiovascular
Irregularly irregular. Parasternal holosystolic murmur. +RV gallop. JVP 20 cm H2O at 30 degrees.
PA pressure
32/23 mmHg, mean 27 mmHg
Lungs
Coarse breath sounds. No wheezes. Normal work of breathing.
PCWP
18 mmHg
Abdomen
Soft, normoactive bowel sounds. Moderate to severe hepatomegaly with hepatojugular reflux.
Pulmonary vascular resistance
3.8 WU
Extremities
2+ pitting edema to knees. No cyanosis or clubbing.
Cardiac output (L/min) (thermal dilution)
3.91 (L/min), Sv02-53%, Hgb 15.2
Skin
Slightly cool extremities.
Cardiac index
1.70 L/min/m2
(b)
Physical exam
Vital signs MAP 72 mmHg, HR 85 bpm, RR 14/min
Right heart catheterization
Measurements
General
Brighter affect.
RA mean pressure
5 mmHg
Head, neck, throat
Moist mucous membranes.
RV pressure
26/5 mmHg
Cardiovascular
Irregularly irregular. Parasternal soft holosystolic murmur. JVP 8 cm H2O at 30 degrees.
PA pressure
26/15 mmHg, mean 19 mmHg
Lungs
Clear breath sounds. No wheezes. Normal work of breathing.
