Acute Cholecystitis Masking Right-Sided Heart Failure: A Near-Miss Event

IntroductionPulmonary hypertension (PAH) may lead to progressive right-ventricular (RV) heart failure with symptoms of hypervolemia such as renal or hepatic congestion. We present a case critically ill patient presenting sepsis from acute cholecystitis, which was later unmasked RV due uncontrolled PAH.Case ReportA 67-year-old female known PAH presented 4 days right upper quadrant abdominal pain and emesis. She tachycardic hypotensive. CT imaging showed thick, fluid-filled gallbladder ascites concerning for cholecystitis. Lab testing revealed lactic acid 10 leukocytosis 11,000. managed IV antibiotics planned surgery, until bedside echocardiogram dilated RA severe tricuspid regurgitation. A catheterization confirmed severely elevated pressures. started on treprostinil, milrinone, diuretics resolution acidosis pain.Decision MakingThe patient's history along evidence led suspicion the cause This changes in management by holding fluids would otherwise be indicated prompting an urgent catheterization. The diagnosis she appropriate therapy.SummaryUnderstanding complications failure, can produce similar syndrome, prompt early interventions prevent potentially harmful management. Pulmonary PAH. pain. therapy. Understanding