A Case of Acute Heart Failure With Intravenous Acetazolamide Administration for Evaluation of Cerebrovascular Reactivity

Abstract

A man in his seventies presented with a history of cerebral infarction with occlusion of the left middle cerebral artery, diabetes mellitus, renal dysfunction, as well as prior myocardial infarction and arteriosclerosis obliterans. About 45 min after intravenous administration of 1,000 mg of acetazolamide for acetazolamide-augmented cerebrovascular single-photon emission computed tomography, he experienced dyspnea and tightness in his chest which worsened. Hypertension, regular tachycardia, and wheezing and rales were noted. Symptoms and vital signs did not improve despite many life-saving treatments. In patients with severe coronary artery disease with low ischemic threshold, as in the present case, acetazolamide might reduce peripheral vascular resistance, increase the cardiac output ratio, increase myocardial oxygen consumption by increasing cardiac output, and induce myocardial ischemia with elevation of double product. Although the frequency of acute heart failure due to myocardial ischemia after an acetazolamide challenge may be low, its occurrence in patients with severe arteriosclerotic disease should be routinely considered.




J Med Cases. 2013;4(7):495-498
doi: http://dx.doi.org/10.4021/jmc1315w