Dean John-Henry L, Patel Mayank P, Corpuz Elaine, Cahill Michael S, Fentanes Emilio
Department of Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX, 78234, USA.
Department of Cardiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX, 78234, USA.
Eur Heart J Case Rep. 2023 Mar 9;7(3):ytad060. doi: 10.1093/ehjcr/ytad060. eCollection 2023 Mar.
Utilization of sacubitril/valsartan is increasing as a component of guideline-directed medical therapy in patients with heart failure with reduced ejection fraction (HFrEF). Common adverse effects associated with the medication such as hypotension and hyperkalaemia have been described; however, hyponatraemia is very rarely reported to have a potential association with use of the medication. In this report, we describe what we believe to be the first reported case of acute hyponatraemia likely attributable to inpatient initiation of sacubitril/valsartan.
A 71-year-old female presented with 2 weeks of progressively worsening dyspnoea and orthopnoea. Bedside echocardiography identified a dilated cardiomyopathy with an estimated left ventricular ejection fraction <30% and diffuse hypokinesis, and given the associated clinical syndrome, she was diagnosed with heart failure with reduced ejection fraction. In conjunction with diuresis, guideline-directed medical therapy was initiated. She developed acute worsening of her previously mild hyponatraemia shortly after starting sacubitril/valsartan, and this improved following discontinuation of the medication. She was subsequently able to tolerate losartan while maintaining eunatraemia, and her ejection fraction improved to 46% on repeat imaging.
Angiotensin receptor-neprilysin inhibitors are an integral component of guideline-directed medical therapy with proven benefits for patients with heart failure with reduced ejection fraction. Although the association between use of these medications and hyponatraemia appears to be exceedingly rare, clinicians should maintain awareness of this potential adverse effect.
沙库巴曲缬沙坦作为射血分数降低的心力衰竭（HFrEF）患者指南导向药物治疗的一部分，其使用正在增加。已描述了与该药物相关的常见不良反应，如低血压和高钾血症；然而，低钠血症与该药物使用的潜在关联却鲜有报道。在本报告中，我们描述了我们认为可能是首例因住院起始使用沙库巴曲缬沙坦导致急性低钠血症的病例。
一名71岁女性，出现进行性加重的呼吸困难和端坐呼吸2周。床边超声心动图显示扩张型心肌病，估计左心室射血分数<30%，弥漫性运动减弱，鉴于相关临床综合征，她被诊断为射血分数降低的心力衰竭。在利尿的同时，启动了指南导向的药物治疗。在开始使用沙库巴曲缬沙坦后不久，她之前轻度的低钠血症急性加重，停药后有所改善。随后，她能够耐受氯沙坦，同时维持血钠正常，复查影像学检查时射血分数提高到46%。
血管紧张素受体脑啡肽酶抑制剂是指南导向药物治疗的重要组成部分，已证实对射血分数降低的心力衰竭患者有益。尽管这些药物的使用与低钠血症之间的关联似乎极为罕见，但临床医生应意识到这种潜在的不良反应。
