Department of Cardiology, Aichi Medical University, Nagakute, Japan
Department of Cardiology, Aichi Medical University, Nagakute, Japan.
BMJ Case Rep. 2021 Nov 30;14(11):e246011. doi: 10.1136/bcr-2021-246011.
A 65-year-old man with a history of heart failure with reduced ejection fraction (HFrEF) and renal failure was admitted due to difficulty in fluid volume control during haemodialysis. He had frequent episodes of intradialytic hypotension (IDH) with presyncope during haemodialysis despite using a vasopressor agent. Before haemodialysis, his blood pressure was 130-150/60-70 mm Hg, and his heart rate was 80-100 beats/min. There were no specific causes of IDH. For refractory IDH, he was treated with oral ivabradine (2.5 mg two times per day), which resulted in reduced heart rate and decreased occurrence of IDH. This is the first report to describe a dialysis case with HFrEF presenting with an elevated heart rate and impaired fluid management as manifested by recurring IDH, which improved after ivabradine treatment. Ivabradine therapy may assist in increasing stroke volume by lowering the sinus heart rate, thus resulting in the prevention of IDH.
一位 65 岁男性，既往有射血分数降低的心力衰竭（HFrEF）和肾衰竭病史，因血液透析期间液体容量控制困难而入院。尽管使用了血管加压药，但他在血液透析期间仍频繁出现低血压伴晕厥。血液透析前，他的血压为 130-150/60-70mmHg，心率为 80-100 次/分。没有明确的低血压原因。对于难治性低血压，他接受了口服伊伐布雷定（2.5mg，每日两次）治疗，结果心率降低，低血压发作减少。这是首例描述 HFrEF 透析患者出现心动过速和液体管理受损的病例，表现为反复发生低血压，伊伐布雷定治疗后得到改善。伊伐布雷定治疗可能通过降低窦性心率来增加心输出量，从而预防低血压。
