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Hypertensive cardiomyopathy (HTN-CM) is of the common complication of long standing uncontrolled systemic hypertension. While in hypertension with hypokalaemia, Conn's syndrome is one of the common causes for resistant hypertension leading early development of HTN-CM. Here, we reported a case of HTN-CM with possibility of underlying Conn’s Syndrome.
A decision to withhold HF-GDMT temporarily in order to properly investigate and confirm the diagnosis of Con’s Syndrome, might results in worsening of the HF symptoms which can lead to increase in HF morbidity and mortality. On the other hand, future risk of accelerated HTN with Conn’s Syndrome also poses a significant challenge.
A 40-year-old serviceman came with history of reduce effort tolerance for 2 months and elevated BP of 160/95mmHg. His ECG and CXR point towards diagnosis of HF. Echo shows EF of 31%. Baseline serum potassium noted to be 2.3mmol/L with TTKG of 6. He was started with 4 pillars of HF GDMT. Repeated Echo shows improvement of EF to 49% after 6 months of therapy with good BP control of <130/80mmHg. His NT-Pro BNP normalized from 864 to <60pg/ml. His potassium remains to be <3.5mmol/L despite on MRAand oral potassium tablets. CT adrenal shows left adrenal enlargement suggestive of Conn’s Syndrome. However, evaluation of plasma Renin and Aldosterone were not done with all the HF GDMT medications on board.
HTN-CM especially in young patient, optimization of HF GDMT seems to be more important in order to prevent potential lethal complications of HF.
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