Management of a Patient with Severe Hypotension and Advanced Heart Failure with Reduced Left Ventricular Ejection Fraction

Hypotension is often in chronic heart failure patients. It has various reasons, including a decrease in the pumping function of the heart, medications, altered vasoreactivity associated with concomitant diseases (for example, diabetes mellitus). There are no universal criteria for assessing the severity of hypotension. Its prognosis significance has not been studied well. It is difficult to select and titrate the drugs recommended for treatment of heart failure, so that the prescribed therapy compensates the patient and does not cause the development of side effects. Step–by–step algorithms for prescribing and correcting drug therapy for heart failure patients with hypotension have been developed. This article presents a clinical case of management of a patient with severe hypotension and chronic heart failure with a reduced left ventricular ejection fraction.

Aortic valve replacement was performed the patient with congenital heart disease (bicuspid aortic valve) in 25 years. In 13 years, after a viral infection, there was a decompensation of chronic heart failure with reduced ejection fraction to 19%. Against the optimal drug therapy, heart failure persisted III– IV functional class with 4 hospitalization during a year. Despite the indications for cardiac resynchronization therapy, a system for modulating cardiac contractility was implanted, after which there was no improvement in clinical symptoms, there were frequent decompensations up to. In order to prevent the progression of the disease and improve the prognosis, despite hypotension, sacubitril/valsartan was prescribed, against which it was possible to compensate the patient and achieve a stable course of chronic heart failure without the need for hospitalization for 9 months. This case report suggest that additional clinical researches are necessary to study the possibility of prescribing of small doses of sacubitril/valsartan in patients with hypotension and heart failure to reduce the severity of clinical symptoms and to improve the prognosis.

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