Author/Authors :
Rigger, Wytch Department of Medicine - Medical College of Georgia at Augusta University, Augusta, GA, USA , Javaheri, Sean P. Division of Cardiology - Medical College of Georgia at Augusta University, Augusta, GA, USA , Sharma, Gyanendra K. Division of Cardiology - Medical College of Georgia at Augusta University, Augusta, GA, USA , Nahman Jr., Norris Stanley Division of Nephrology - Medical College of Georgia at Augusta University, Augusta, GA, USA , Sheynshteyn, Mark Division of Endocrinology Diabetes and Metabolism - Medical College of Georgia at Augusta University, Augusta, GA, USA , Weintraub, Neal L. Division of Cardiology - Medical College of Georgia at Augusta University, Augusta, GA, USA
Abstract :
An adult with surgically corrected Tetralogy of Fallot presented with profoundly elevated central venous pressure (CVP) and acute
renal dysfunction thought secondary to acute on chronic right heart failure. Treatment with dopamine promoted diuresis and a
stabilization of renal function. Repeated attempts to wean the patient from dopamine were associated with hypotension and
worsening renal failure. Invasive hemodynamic assessment unexpectedly demonstrated high cardiac output with low systemic
vascular resistance (SVR). In retrospect, the markedly elevated CVP had concealed the impact of reduced SVR on blood
pressure. After reversible causes of low SVR state were excluded, the patient was successfully managed with oral alphaadrenergic agents. While typically negligible under physiologic conditions, elevated CVP can artificially increase mean arterial
pressure. We have coined the term “masked hypotension” to describe this unique pathophysiological phenomenon.
