Masked Hypotension due to Elevated Venous Pressure in a Patient with Complex Adult Congenital Heart Disease

Figure 2

Plot of serum creatinine and weight over the 30 days after initial presentation. Shaded areas represent time periods where the patient received treatment with intravenous vasopressor agents. Dopamine was used as the vasopressor on days 1-8 and 16-23 while intravenous phenylephrine was used on days 27-29 with the patient being transitioned to oral phenylephrine thereafter. Note that despite correction of volume status by day 10, and the relative stability of weight thereafter, the patient still developed renal failure (second shaded area) supporting a pathophysiologic role for distributive shock in the face of high-output cardiac failure.