Virginia Research Day 2025

Medical Resident Research Case Reports

11 Amphetamine Induced Group I Pulmonary Hypertension: A Case Report of Unforseen Consequences

Diana Duong, DO, PGY3; Anthony Conforti, DO, PGY3; Genesis De Jesus Ramirez, MD, PGY1; Kimberly Bird, MD; Sulaiman Tijani, MD Corresponding author: diana.duong@LPNT.net

Sovah Health – Danville Department of Internal Medicine Residency, Division of Pulmonology and Critical Care Medicine

enterocolitis) with concerns for adrenal insufficiency. Significant labs included B-type natriuretic peptide level >5000 and lactic acid was 1 0.9. Pertinent physical examination findings include elevated jugular venous pressure. The patient was started on empiric antimicrobial therapy and aggressive diuresis. Echocardiogram showed severely enlarged right ventricle, severely dilated right atrium, RVSP 70 mmHg, and PASP mean 65. The patient was later extubated to nasal cannula. Consultation with the patient’s outpatient Pulmonology Clinic showed an official diagnosis of precapillary PAH WHO-1, NYA-FC III, and their recommendations included continuing her sildenafil 20mg TID and increasing her Uptravi to 800mcg BID. The patient was discharged home with close follow-up with her Pulmonologist. Discussion: The patient’s history of years of amphetamine use is the suspected etiology of her

PAH, as other causes have been ruled out. Diagnosis confirmation is made with right heart catheterization and treatment of group I PAH includes discontinuation of causative agent. In patients classified as intermediate-high risk based on their REVEAL score, PAH therapy should be initiated with endothelin receptor antagonist (bosentan), phosphodiesterase type 5 inhibitor (sildenafil), soluble guanylate cyclase stimulator (riociguat), prostanoid (epoprostenol), and/or prostacyclin agents (selexipag, and treprostinil). Treatment of PAH can be challenging as hemodynamics can be compromised with induction of these vasodilative agents; however, is necessary to prevent progression of PH to advanced stages.

Introduction: Pulmonary hypertension (PH) is a medical condition in which there is hypertension in the lungs. There are five different groups of PH and different types require different forms of treatment. Advanced stage PH can be life-threatening if not treated. Case Description: The patient is a 35-year-old female with past medical history of cor pulmonale, preserved left ventricular function (EF 65-70%), pulmonary arterial hypertension (PAH), asthma, tobacco dependency, generalized anxiety disorder, polysubstance use of amphetamines and marijuana who presented for shortness of breath. She became unresponsive and was intubated for acute hypoxic respiratory failure secondary to hypervolemia from heart failure decompensation and was also in multifactorial shock (cardiogenic shock from heart failure decompensation and septic shock from

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