Recurrent hypotension induced by sacubitril/valsartan in cardiomyopathy secondary to Duchenne muscular dystrophy: A case report

Figure 1 Electrocardiogram recorded at the Emergency Department. The electrocardiogram shows atrial tachycardia with Wenckebach block, Q waves in leads I, V₅ and V₆, and large R waves in leads V₁ and V₂.

Figure 2 Echocardiogram of the patient. A: Parasternal long axis view; B: Apical four-chamber view. Whole heart enlargement with cardiac dysfunction was found with mild mitral regurgitation, mild to moderate tricuspid regurgitation and moderate pulmonary hypertension (PASP = 51 mmHg). The left ventricular ejection fraction was 23% as calculated using Simpson’s Formula.

Figure 3 Cardiac magnetic resonance imaging of the patient. A, B: Long-axis view of the heart, in diastole (A) and systole (B); C, D: With late gadolinium enhancement imaging, the short-axis view (C) and long-axis view (D) demonstrated multi-segmental abnormal enhancement at lateral, anterolateral and part of the inferior wall of the left ventricle.

Figure 4 Electrocardiogram at the time of symptom relief. Electrocardiogram shows sinus rhythm, right heart hypertrophy, Q waves in leads I, V₅ and V₆, and large R waves in leads V₁ and V₂.