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Gerges C, Gerges M, Lang MB et al. Diastolic pulmonary vascular pressure gradient: A Predictor of prognosis in “out-of-proportion” pulmonary hypertension. CHEST 2013; 143: 758-766.

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Protein-losing Enteropathy in Association with Right Heart Failure

1Division of Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan

2Division of Cardiology, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan


American Journal of Medical Case Reports. 2016, Vol. 4 No. 12, 389-392
DOI: 10.12691/ajmcr-4-12-5
Copyright © 2016 Science and Education Publishing

Cite this paper:
Takanobu Hirosawa, Kazuhito Hirata, Wake Minoru. Protein-losing Enteropathy in Association with Right Heart Failure. American Journal of Medical Case Reports. 2016; 4(12):389-392. doi: 10.12691/ajmcr-4-12-5.

Correspondence to: Kazuhito  Hirata, Division of Internal Medicine, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, Japan. Email: kheart911@yahoo.co.jp

Abstract

A 65-year-old woman, with past history of mitral valve replacement, developed severe right heart failure. In addition to elevated right heart pressure, she had significant hypoalbuminemia as the important cause of refractory edema. Technetium-99m-labelled human serum albumin scintigraphy showed leak of protein from the transverse colon and the excretion of alpha 1 antitrypsin in the stool was markedly increased. Diagnosis of protein losing enteropathy was established. The etiology was increased lymphatic pressure secondary to right heart failure of multifactorial cause, including elevated left side filling pressures and out of proportion pulmonary hypertension due to old tuberculosis, resulting in significant tricuspid regurgitation. The patient was managed conservatively with increased dose of furosemide from 10-20mg every other day up to 40-60mg/day, and maximum dose of tolvaptan (a vasopressin 2 receptor blocker) of 15mg/ day, in addition to high protein diet.

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