1997 Volume 30 Issue 2 Pages 147-152
We report a case of sudden blood pressure drop during hemodialysis (HD) caused by mid-ventricular obstruction with hypertrophic cardiomyopathy. A 57-year-old female, who had been undergoing chronic HD therapy due to nephrosclerosis since April 1989, was admitted to our hospital because of left lower leg pain at rest. After admission, sudden drops in blood pressure were frequently observed during HD. As an angiographic study disclosed severe narrowing of the left femoral arterial lumen, she underwent aorto-femoral bypass sugery. Intraoperatively, her blood pressure dropped due to perioperative events. Thus, catecholamines were administered intravenously in order to maintain blood pressure. However, her blood pressure became much lower and discontinuation of the catecholamines reversed the blood pressure fall. Cardiac catheterization examination and dobutamine loading echocardiography revealed a left venricular obstruction at the level of the papillary muscles, the existence of a pressure gradient at the left venricular pre-out flow tract and a change in the pressure gradient during HD. Therefore, we concluded that the hypotension during HD was caused by mid-ventricular obstruction associated with hypertrophic cardiomyopathy. A β-blocking agent decreased the mid-venricular pressure gradient and obliterated the sudden blood pressure falls during HD.
