The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection
The carotid sinus-arterial baroreflex is essential in maintaining blood pressure (BP) regulation. Afferent baroreflex failure (ABF) can present with labile changes in BP within seconds and can be secondary to neck surgery or radiation. We present here the first case, to our knowledge, of ABF precipi...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-02-01
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| Series: | Radiology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043322010147 |
| _version_ | 1811197274430111744 |
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| author | Anas Mahmoud, MD Brooke Kania, DO Shady Geris, DO Wadah Akroush, MD Rajapriya Manickam, MD Moh'd Hazem K Azzam, MD |
| author_facet | Anas Mahmoud, MD Brooke Kania, DO Shady Geris, DO Wadah Akroush, MD Rajapriya Manickam, MD Moh'd Hazem K Azzam, MD |
| author_sort | Anas Mahmoud, MD |
| collection | DOAJ |
| description | The carotid sinus-arterial baroreflex is essential in maintaining blood pressure (BP) regulation. Afferent baroreflex failure (ABF) can present with labile changes in BP within seconds and can be secondary to neck surgery or radiation. We present here the first case, to our knowledge, of ABF precipitated by thyroidectomy, in a patient with active COVID-19 pneumonia, causing difficult control of severely labile BP in a critical care unit. Contributing factors included her critical illness state with upregulation of IL-6 leading to pituitary-adrenal axis alteration, her thyroidectomy further exacerbating autonomic dysfunction, as well as downregulation of ACE2 via COVID-19 infection. Management was achieved with a combination of midodrine and clonidine catered to specific BP thresholds. Additional research with a multidisciplinary approach is warranted to fully optimize the treatment of ABF in patients with neck surgery and or inflammatory conditions such as COVID-19. |
| first_indexed | 2024-04-12T01:11:22Z |
| format | Article |
| id | doaj.art-b700603ff82641f4b8ec31c7c6e85cf4 |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-04-12T01:11:22Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-b700603ff82641f4b8ec31c7c6e85cf42022-12-22T03:54:05ZengElsevierRadiology Case Reports1930-04332023-02-01182715718The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infectionAnas Mahmoud, MD0Brooke Kania, DO1Shady Geris, DO2Wadah Akroush, MD3Rajapriya Manickam, MD4Moh'd Hazem K Azzam, MD5Department of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USADepartment of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USA; Corresponding author.Department of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USADepartment of Medicine, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USADepartment of Critical Care, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USADepartment of Critical Care, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, USAThe carotid sinus-arterial baroreflex is essential in maintaining blood pressure (BP) regulation. Afferent baroreflex failure (ABF) can present with labile changes in BP within seconds and can be secondary to neck surgery or radiation. We present here the first case, to our knowledge, of ABF precipitated by thyroidectomy, in a patient with active COVID-19 pneumonia, causing difficult control of severely labile BP in a critical care unit. Contributing factors included her critical illness state with upregulation of IL-6 leading to pituitary-adrenal axis alteration, her thyroidectomy further exacerbating autonomic dysfunction, as well as downregulation of ACE2 via COVID-19 infection. Management was achieved with a combination of midodrine and clonidine catered to specific BP thresholds. Additional research with a multidisciplinary approach is warranted to fully optimize the treatment of ABF in patients with neck surgery and or inflammatory conditions such as COVID-19.http://www.sciencedirect.com/science/article/pii/S1930043322010147Afferent baroreflex failureCOVID-19 pneumoniaHead and neck surgeryThyroidectomyLabile blood pressure |
| spellingShingle | Anas Mahmoud, MD Brooke Kania, DO Shady Geris, DO Wadah Akroush, MD Rajapriya Manickam, MD Moh'd Hazem K Azzam, MD The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection Radiology Case Reports Afferent baroreflex failure COVID-19 pneumonia Head and neck surgery Thyroidectomy Labile blood pressure |
| title | The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection |
| title_full | The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection |
| title_fullStr | The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection |
| title_full_unstemmed | The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection |
| title_short | The unpredictability of labile blood pressure: Afferent baroreflex failure in a critical patient with multiple thyroid surgeries and COVID-19 infection |
| title_sort | unpredictability of labile blood pressure afferent baroreflex failure in a critical patient with multiple thyroid surgeries and covid 19 infection |
| topic | Afferent baroreflex failure COVID-19 pneumonia Head and neck surgery Thyroidectomy Labile blood pressure |
| url | http://www.sciencedirect.com/science/article/pii/S1930043322010147 |
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