Transient acute decompensated heart failure following propofol and fentanyl administration in a healthy 19-year-old patient

Additive effect of propofol and fentanyl precipitating cardiogenic shock

The intravenous administration of propofol and fentanyl has become a common practice in a variety of clinical settings including outpatient dermatologic, cosmetic and oral surgery. The combination provides both systematic sedation and analgesia with low incidence of unwanted side effects. The cardiogenic shock is very uncommon in healthy individuals. The cardiovascular depressive effect of propofol and fentanyl has been well established, but the development of cardiogenic shock is very rare when these drugs are used together. Hence the awareness of this effect is advantageous to the patients undergoing such surgeries

Potential for Infra-Nodal Heart Block and Cardiogenic Shock With Propofol Administration

We report a case of infra-nodal complete heart block and cardiogenic shock in a previously healthy 64-year-old man after administration of 180 mg of intravenous Propofol. Although bradycardia, hypotension, and heart block are commonly seen with propofol administration, such findings are transient and respond quickly to administration of vagolytic or sympathomimetic agents suggesting an AV nodal mechanism of heart block. Sustained left ventricular systolic dysfunction and cardiogenic shock by an alternative, non-autonomic mechanism has also been described in the setting of Propofol administration. Our case is the first to note sustained complete infra-nodal heart block in this setting. Early recognition of such a complication, restoration of atrio-ventricular (A-V) synchrony with dual chamber pacing, and aggressive circulatory support is essential in bridging such patients to recovery.

Cardiogenic shock following administration of propofol and fentanyl in a healthy woman: a case report

Introduction

Cardiogenic shock is very uncommon in healthy people. The differential diagnosis for patients with acute heart failure in previously healthy hearts includes acute myocardial infarction and myocarditis. However, many drugs can also depress myocardial function. Propofol and fentanyl are frequently used during different medical procedures. The cardiovascular depressive effect of both drugs has been well established, but the development of cardiogenic shock is very rare when these agents are used.

Case presentation

After a minor surgical intervention, a 32-year-old Caucasian woman with no significant medical history went into sudden hemodynamic deterioration due to acute heart failure. An urgent echocardiogram showed severe biventricular dysfunction and an estimated left ventricular ejection fraction of 20%. Extracorporeal life support and mechanical ventilation were required. Five days later her ventricular function had fully recovered, which allowed the progressive withdrawal of medical treatment. Prior to her hospital discharge, cardiac MRI showed neither edema nor pathological deposits on the delayed contrast enhancement sequences. At her six-month follow-up examination, the patient was asymptomatic and did not require treatment.

Conclusion

Although there are many causes of cardiogenic shock, the presence of abrupt hemodynamic deterioration and the absence of a clear cause could be related to the use of propofol and fentanyl.