Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2019; 7(23): 4098-4105
Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4098
Recurrent hypotension induced by sacubitril/valsartan in cardiomyopathy secondary to Duchenne muscular dystrophy: A case report
Jia-Min Li, Han Chen
Jia-Min Li, Han Chen, Department of Cardiology, Zhejiang Provincial Key Laboratory of Cardiovascular Disease Diagnosis and Treatment, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
Author contributions: Li JM and Chen H were the patient’s physicians; they also reviewed the literature and contributed to drafting the manuscript. Chen H was responsible for revising the manuscript for important intellectual content. All authors issued final approval for the version to be submitted.
Supported by Natural Science Foundation of Zhejiang Province, No. LQ16H020004.
Informed consent statement: Informed written consent was obtained from the patient and families for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have carefully read the CARE Checklist (2016), and the manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Han Chen, MD, PhD, Doctor, Department of Cardiology, Zhejiang Provincial Key Laboratory of Cardiovascular Disease Diagnosis and Treatment, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. chenhanzju@zju.edu.cn
Telephone: +86-571-87315198 Fax: +86-571-87022776
Received: June 20, 2019
Peer-review started: June 26, 2019
First decision: November 12, 2019
Revised: November 17, 2019
Accepted: November 20, 2019
Article in press: November 20, 2019
Published online: December 6, 2019
Processing time: 169 Days and 23.3 Hours
Abstract
BACKGROUND

Duchenne muscular dystrophy (DMD), which is caused by a mutation/deletion in the dystrophin gene on the X-chromosome, is the most common type of neuromuscular disorder in pediatrics. Skeletal muscle weakness progressively develops in DMD patients and usually leads to respiratory failure in the early adolescent years. Cardiac muscle is frequently affected in DMD patients, which leads to a high burden of cardiomyopathy and heart failure. In the era of improved respiratory care, cardiac deaths are becoming the major cause of mortality in DMD patients.

CASE SUMMARY

We report the case of a 15-year-old boy who presented to the hospital due to recurrent orthopnea for 6 mo and palpitations for 4 mo. He was diagnosed with progressive muscular dystrophy at the age of 3 years and was confined to a wheelchair at 12 years. He was prescribed diuretics and digoxin at the outpatient clinic; however, his symptoms did not resolve. Sacubitril/valsartan was added 1 mo prior to presentation, but he experienced recurrent episodes of palpitations. The electrocardiogram showed atrial tachycardia with a heart rate of 201 bpm, and he was then hospitalized. Hypotension was found following the administration of sacubitril/valsartan tablets; he could not tolerate even a small dose, always developing tachyarrhythmia. His symptoms were relieved after discontinuing sacubitril/valsartan, and his heart rate was controlled by a small dose of metoprolol tartrate and digoxin. Atrial tachycardia spontaneously converted in this patient, and his symptoms attenuated in the following 6 mo, without palpitation episodes.

CONCLUSION

Blood pressure should be closely monitored in DMD patients with advanced heart failure when taking sacubitril/valsartan.

Keywords: Sacubitril/valsartan; Duchenne muscular dystrophy; Heart failure; Hypotension; Case report

Core tip: A 15-year-old boy with Duchenne muscular dystrophy presented to the hospital due to recurrent orthopnea for 6 mo. He was diagnosed with heart failure and was prescribed oral diuretics and digoxin at the outpatient clinic, but his symptoms did not resolve. Sacubitril/valsartan was added to his therapeutic regimen 1 mo before presentation, but resulted in recurrent hypotension and palpitation episodes until discontinuation of this medication. Although sacubitril/valsartan has been shown to be beneficial for heart failure with a reduced ejection fraction, hypotension is a common side effect of this medication, and blood pressure should be closely monitored in Duchenne muscular dystrophy patients with advanced heart failure.