Central volume shift in acute heart failure revealed by blood volume monitoring during haemodialysis

Central volume shift is one of the major pathophysiological mechanisms of acute pulmonary oedema in acute heart failure (AHF). Pathological vasoconstriction results in central volume shift; however, its onset and course have been rarely detected or recorded in clinical practice. We report an exceptional case of AHF developing during haemodialysis, with marked blood pressure (BP) elevation and paradoxical repeated reduction in blood volume (BV) detected by real-time BV monitoring, accompanied by worsening dyspnoea. This inverse correlation of BV and BP during haemodialysis indicates that the theoretical central volume shift was captured in real-world AHF.

Automated summary

This case report highlights the rare detection of central volume shift as a major pathophysiological mechanism of acute pulmonary oedema in acute heart failure during haemodialysis. The inverse correlation of blood volume and blood pressure during haemodialysis suggests that the theoretical central volume shift was captured in real-world AHF.