1
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Canakci ME, Sevik OE, Seyran H, Karakus E, Mert GO. Woman With Dyspnea. Ann Emerg Med 2024; 84:201-202. [PMID: 39032979 DOI: 10.1016/j.annemergmed.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Mustafa E Canakci
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Omer Erdem Sevik
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Huseyin Seyran
- Emergency Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Emre Karakus
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Gurbet Ozge Mert
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
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2
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Omori A, Toyota T, Arizono S, Okada T, Kim K, Furukawa Y. Localized Pulmonary Edema Secondary to Pulmonary Embolism. JACC Case Rep 2024; 29:102332. [PMID: 38680130 PMCID: PMC11047289 DOI: 10.1016/j.jaccas.2024.102332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 05/01/2024]
Abstract
A 47-year-old man had localized pulmonary edema (LPE) and a massive pulmonary embolism. The cause of LPE was believed to be a high blood supply to the spared pulmonary artery territories without a thrombus. The patient was successfully treated with unfractionated heparin and thrombolytic agents.
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Affiliation(s)
- Aoi Omori
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshiaki Toyota
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shigeki Arizono
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Taiji Okada
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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3
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Degefu N, Jambo A, Nigusse S, Dechasa M, Gashaw T, Getachew M. The Burden and Contributing Factors of Cardiogenic Pulmonary Edema Among Acute Heart Failure Patients Admitted to Tertiary Hospital, Eastern Ethiopia. Open Access Emerg Med 2023; 15:405-414. [PMID: 37965444 PMCID: PMC10642536 DOI: 10.2147/oaem.s436352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023] Open
Abstract
Background Despite cardiogenic pulmonary edema is the most common phenotype of acute heart failure (AHF), studies on its burden and associated factors are limited. This study aimed to assess the burden and contributing factors of cardiogenic pulmonary edema in patients with acute heart failure admitted to a tertiary hospital in eastern Ethiopia. Patients and Methods An institution-based cross-sectional study was conducted on the medical records (n = 276) of patients with AHF between February 01, 2018, and January 31, 2023. A simple random sampling technique was used to select participants from the study population. Bivariable and multivariable logistic regression analyses were used to assess factors associated with the development of cardiogenic pulmonary edema. A P-value ≤0.05 was considered as statistically significant. Results The prevalence of cardiogenic pulmonary edema was 47.8% in AHF patients. Rural residence (adjusted odds ratio (AOR),9.54), smoking (AOR,3.17), comorbidity (AOR,2.1), and underlying cardiovascular disease (ischemic heart disease, chronic rheumatic valvular heart disease, and hypertensive heart disease with AOR: 6.71, 8.47, and 12.07, respectively) were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF. Conclusion Nearly half of the patients with AHF had cardiogenic pulmonary edema. Being a rural dweller, cigarette smoking, comorbidities, and underlying cardiac illness were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.
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Affiliation(s)
- Natanim Degefu
- Department of Pharmaceutics, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Abera Jambo
- Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Shambel Nigusse
- Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Mesay Dechasa
- Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology, School of Pharmacy, Haramaya University, Harar, Ethiopia
| | - Melaku Getachew
- Department of Emergency and Critical Care Medicine, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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4
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Zanza C, Saglietti F, Tesauro M, Longhitano Y, Savioli G, Balzanelli MG, Romenskaya T, Cofone L, Pindinello I, Racca G, Racca F. Cardiogenic Pulmonary Edema in Emergency Medicine. Adv Respir Med 2023; 91:445-463. [PMID: 37887077 PMCID: PMC10604083 DOI: 10.3390/arm91050034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
Cardiogenic pulmonary edema (CPE) is characterized by the development of acute respiratory failure associated with the accumulation of fluid in the lung's alveolar spaces due to an elevated cardiac filling pressure. All cardiac diseases, characterized by an increasing pressure in the left side of the heart, can cause CPE. High capillary pressure for an extended period can also cause barrier disruption, which implies increased permeability and fluid transfer into the alveoli, leading to edema and atelectasis. The breakdown of the alveolar-epithelial barrier is a consequence of multiple factors that include dysregulated inflammation, intense leukocyte infiltration, activation of procoagulant processes, cell death, and mechanical stretch. Reactive oxygen and nitrogen species (RONS) can modify or damage ion channels, such as epithelial sodium channels, which alters fluid balance. Some studies claim that these patients may have higher levels of surfactant protein B in the bloodstream. The correct approach to patients with CPE should include a detailed medical history and a physical examination to evaluate signs and symptoms of CPE as well as potential causes. Second-level diagnostic tests, such as pulmonary ultrasound, natriuretic peptide level, chest radiograph, and echocardiogram, should occur in the meantime. The identification of the specific CPE phenotype is essential to set the most appropriate therapy for these patients. Non-invasive ventilation (NIV) should be considered early in the treatment of this disease. Diuretics and vasodilators are used for pulmonary congestion. Hypoperfusion requires treatment with inotropes and occasionally vasopressors. Patients with persistent symptoms and diuretic resistance might benefit from additional approaches (i.e., beta-agonists and pentoxifylline). This paper reviews the pathophysiology, clinical presentation, and management of CPE.
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Affiliation(s)
- Christian Zanza
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Italian Society of Prehospital Emergency Medicine (SIS 118), 74121 Taranto, Italy
| | - Francesco Saglietti
- Department of Emergency and Critical Care, Santa Croce and Carle Hospital, 12100 Cuneo, Italy
| | - Manfredi Tesauro
- Post Graduate School of Geriatric Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Emergency Medicine, Humanitas University Hospital, 20089 Rozzano, Italy
| | - Gabriele Savioli
- Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | | | - Tatsiana Romenskaya
- Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy
| | - Luigi Cofone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.C.); (I.P.)
| | - Ivano Pindinello
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (L.C.); (I.P.)
| | - Giulia Racca
- Division of Anesthesia and Critical Care Medicine, AO Ordine Mauriziano, 10128 Turin, Italy; (G.R.)
| | - Fabrizio Racca
- Division of Anesthesia and Critical Care Medicine, AO Ordine Mauriziano, 10128 Turin, Italy; (G.R.)
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5
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Fukuda M, Sakai H, Koh K, Sakuraba S, Ando N, Hayashida M, Kawagoe I. Unusual severe hypoxemia due to unilateral pulmonary edema after conventional cardiopulmonary bypass salvaged by veno-venous extracorporeal membrane oxygenation: a case report. JA Clin Rep 2023; 9:65. [PMID: 37803183 PMCID: PMC10558410 DOI: 10.1186/s40981-023-00656-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND We report a case in which veno-venous extracorporeal membrane oxygenation (V-V ECMO) saved the life of a patient who developed severe hypoxemia due to unusual unilateral pulmonary edema (UPE) after cardiopulmonary bypass (CPB). CASE PRESENTATION A 69-year-old man underwent aortic valve replacement and coronary artery bypass grafting. Following uneventful weaning off CPB, he developed severe hypoxemia. The ratio of arterial oxygen tension to inspired oxygen fraction (PaO2/FiO2) decreased from 301 mmHg 5 min after CPB to 42 mmHg 90 min after CPB. A chest X-ray revealed right-sided UPE. Immediately established V-V ECMO increased PaO2/FiO2 to 170 mmHg. Re-expansion pulmonary edema (REPE) was likely, as the right lung remained collapsed during CPB following the accidental opening of the right chest cavity during graft harvesting. CONCLUSIONS V-V ECMO was effective in improving oxygenation and saving the life of a patient who had fallen into unilateral REPE unusually developing after conventional CPB.
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Affiliation(s)
- Masataka Fukuda
- Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan
| | - Hiroaki Sakai
- Department of Anesthesia, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Keito Koh
- Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Sonoko Sakuraba
- Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Nozomi Ando
- Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan.
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Sriboonyong T, Katanyuwong P, Vaewpanich J. A unilateral whiteout lung in child with multisystem inflammatory syndrome associated with COVID-19 due to SARS-CoV-2: one case report of a boy. BMC Pulm Med 2023; 23:157. [PMID: 37143019 PMCID: PMC10157560 DOI: 10.1186/s12890-023-02428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/10/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a relatively new and rare complication of COVID-19. This complication seems to develop after the infection rather than during the acute phase of COVID-19. This report aims to describe a case of MIS-C in an 8-year-old Thai boy who presented with unilateral lung consolidation. Unilateral whiteout lung is not a common pediatric chest radiograph finding in MIS-C, but this is attributed to severe acute respiratory failure. CASE PRESENTATION An 8-year-old boy presented with persistent fever for seven days, right cervical lymphadenopathy, and dyspnea for 12 h. The clinical and biochemical findings were compatible with MIS-C. Radiographic features included total opacity of the right lung and CT chest found consolidation and ground-glass opacities of the right lung. He was treated with intravenous immunoglobulin and methylprednisolone, and he dramatically responded to the treatment. He was discharged home in good condition after 8 days of treatment. CONCLUSION Unilateral whiteout lung is not a common pediatric chest radiographic finding in MIS-C, but when it is encountered, a timely and accurate diagnosis is required to avoid delays and incorrect treatment. We describe a pediatric patient with unilateral lung consolidation from the inflammatory process.
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Affiliation(s)
- Tidarat Sriboonyong
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poomiporn Katanyuwong
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jarin Vaewpanich
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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7
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Rouzbehani Selakhor J, Molina G, Brunton N, Ohanyan M. Cardiogenic Pneumonia: Unilateral Pulmonary Edema Secondary to Severe Eccentric Mitral Regurgitation. Cureus 2023; 15:e38894. [PMID: 37180544 PMCID: PMC10174632 DOI: 10.7759/cureus.38894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/16/2023] Open
Abstract
Mitral regurgitation (MR), whether primary or secondary, stems from functional or anatomical impairment of components of the mitral apparatus resulting in abnormal blood flow to the left atrium during systole. A common complication is bilateral pulmonary edema (PE), which, in rare instances, may be unilateral and easily misdiagnosed. This case presents an elderly male with unilateral lung infiltrates and progressive exertional dyspnea with the failed treatment of pneumonia. Additional workup, including a transesophageal echocardiogram (TEE), showed severe eccentric MR. He underwent mitral valve (MV) replacement with significant improvement in symptoms.
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Affiliation(s)
| | - Guarina Molina
- Internal Medicine, Danbury Hospital/Yale University School of Medicine, Danbury, USA
| | | | - Manush Ohanyan
- Internal Medicine, Danbury Hospital/Yale University School of Medicine, Danbury, USA
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8
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Plasencia Martínez JM. Schematic approach to the diagnosis of multifocal lung opacities in the emergency department. RADIOLOGIA 2023; 65 Suppl 1:S63-S72. [PMID: 37024232 DOI: 10.1016/j.rxeng.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/21/2022] [Indexed: 04/08/2023]
Abstract
Radiologists in the emergency department must be prepared to deal with any type of disease in any organ at any time. Many entities involving the chest can result in patients' presenting at the emergency department. This chapter deals with entities that manifest with multifocal lung opacities and that can be mistaken for pneumonia. To facilitate their identification, this chapter approaches these entities by considering their most characteristic distribution on chest X-rays, the main diagnostic modality used for thoracic problems in the emergency department. Our schematic approach includes the key findings in patients' personal histories, clinical examination, laboratory tests, and imaging studies that can be available during the initial workup.
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9
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Abordaje esquemático del diagnóstico de las opacidades pulmonares multifocales en la urgencia. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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10
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Yamaguchi D, Tokui T, Narukawa T, Murakami M, Sekoguchi T, Inoue R, Hirano K, Maze Y, Ito H. Surgically-treated hemoptysis and alveolar hemorrhaging resulting from severe mitral regurgitation: A case report. Clin Case Rep 2023; 11:e6924. [PMID: 36794042 PMCID: PMC9923463 DOI: 10.1002/ccr3.6924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/16/2023] Open
Abstract
Cardiac etiologies of hemoptysis are less common. One such etiology includes mitral regurgitation. In patients with hemoptysis and unilateral consolidation, careful chest auscultation and cardiac assessment may assist in making an early diagnosis.
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Affiliation(s)
- Daisuke Yamaguchi
- Department of Cardiovascular and Thoracic SurgeryIse Red Cross HospitalIseJapan
| | - Toshiya Tokui
- Department of Cardiovascular and Thoracic SurgeryIse Red Cross HospitalIseJapan
| | - Takahiro Narukawa
- Department of Cardiovascular and Thoracic SurgeryIse Red Cross HospitalIseJapan
| | - Masahiko Murakami
- Department of Cardiovascular and Thoracic SurgeryIse Red Cross HospitalIseJapan
| | - Tomotake Sekoguchi
- Department of Internal MedicineMinamiise Municipal HospitalMinamiiseJapan
| | - Ryosai Inoue
- Department of Cardiovascular and Thoracic SurgeryIse Red Cross HospitalIseJapan
| | - Koji Hirano
- Department of Cardiovascular and Thoracic SurgeryIse Red Cross HospitalIseJapan
| | - Yasumi Maze
- Department of Cardiovascular and Thoracic SurgeryIse Red Cross HospitalIseJapan
| | - Hisato Ito
- Department of Cardiovascular and Thoracic SurgeryMie University HospitalTsuJapan
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11
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Nishimura YK, Komatsu J, Sugane H, Hosoda H, Imai RI, Nakaoka Y, Nishida K, Seki SI, Kubo T, Yamasaki N, Kitaoka H, Kubokawa SI, Kawai K, Hamashige N, Doi Y. Unilateral Pulmonary Edema in Patients With Acute Mitral Regurgitation Caused by Chordal Rupture. Circ Rep 2022; 4:571-578. [PMID: 36530837 PMCID: PMC9726524 DOI: 10.1253/circrep.cr-22-0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 08/03/2023] Open
Abstract
Background: Cardiogenic unilateral pulmonary edema (UPE) has been reported as an unusual condition and to occur in association with severe mitral regurgitation (MR). However, the prevalence of UPE in patients with severe MR remains unknown. Methods and Results: Among 143 consecutive patients with chordal rupture and significant MR, 38 patients with acute severe MR were studied. The prevalence of UPE was 50% (19 patients); all these patients had right-sided UPE. Eight (21%) patients had bilateral pulmonary edema (BPE). All 8 patients with BPE and 18 of 19 patients with UPE had chordal rupture of the posterior leaflet. All patients with UPE and BPE had severe MR with similar left atrial size. Chest radiographs taken ≤48 h from symptom onset diagnosed UPE in 15 of 19 (79%) patients and BPE in 3 of 8 (38%) patients (P=0.037). Chest radiographs taken >48 h from symptom onset diagnosed UPE in 4 (21%) patients and BPE in 5 (62%) patients (P=0.037). Conclusions: The prevalence of UPE was estimated as 50%; it was most frequently right sided and almost always associated with chordal rupture of the posterior leaflet. UPE is not rare, but common, particularly shortly after the development of acute severe MR caused by chordal rupture.
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Affiliation(s)
- Yu-Ki Nishimura
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Junya Komatsu
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Hiroki Sugane
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Hayato Hosoda
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Ryu-Ichiro Imai
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Yoko Nakaoka
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Koji Nishida
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Shu-Ichi Seki
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Naohito Yamasaki
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Sho-Ichi Kubokawa
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Kazuya Kawai
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Naohisa Hamashige
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Yoshinori Doi
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
- Cardiomyopathy Institute, Chikamori Hospital Kochi Japan
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12
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Kang CY, Khamooshi P, Pinzon VR, Tottleben JM. A rare case of left dominant pulmonary edema in acute mitral regurgitation. Respir Med Case Rep 2022; 40:101746. [PMID: 36324338 PMCID: PMC9618835 DOI: 10.1016/j.rmcr.2022.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
Abstract
Unilateral pulmonary edema (UPE) due to cardiac causes is an unusual clinical finding and typically emerges on the right side. UPE poses a diagnostic challenge due to difficulty distinguishing infiltrative pneumonia from cardiogenic edema on chest imaging. Consequently, corrective clinical management is significantly delayed in UPE compared to bilateral cardiogenic pulmonary edema. We present a very rare case of left-sided cardiogenic pulmonary edema due to acute severe MR wherein a prompt cardiac evaluation for UPE led to successful corrective surgery and favorable outcome.
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Affiliation(s)
- Cyra-Yoonsun Kang
- Department of Medicine, John H. Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL, 60612, USA
| | - Parnia Khamooshi
- Department of Medicine, John H. Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL, 60612, USA
| | - Viviana Reyes Pinzon
- Department of Medicine, John H. Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL, 60612, USA
| | - Jonathan M. Tottleben
- Department of Cardiology, Department of Medicine, John H. Stroger Hospital of Cook County, 1969 W Ogden Ave, Chicago, IL, 60612, USA,Corresponding author.
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13
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Wallis J, Shpigel DI, O'Donnell D, Ponce M, Decaro MJ. Acute Mitral Valve Regurgitation Presenting With Right Upper Lobe Opacification. Cureus 2022; 14:e29078. [PMID: 36259023 PMCID: PMC9564693 DOI: 10.7759/cureus.29078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
There is literature describing unilateral or focal pulmonary edema due to mitral regurgitation. The proposed mechanism is a regurgitant jet propelling blood towards the orifice of a particular pulmonary vein within the left atrium, which selectively pressurizes that vein. The increased hydrostatic pressure is transmitted to the pulmonary capillaries that drain into that vein, causing focal consolidation. A 62-year-old female presented with acute hypoxic respiratory failure. Her dyspnea started suddenly and she was unresponsive when she arrived at the emergency department via emergency medical services. Her initial oxygen saturation was 23% and she was immediately intubated. Sequential chest radiographs demonstrated dense consolidation in the right upper lung field and then opacification of the right hemithorax. These asymmetric lung findings were suspicious for infectious etiology but she was afebrile with no respiratory secretions and had normal inflammatory markers. Echocardiography showed a ruptured anterior papillary muscle causing a flail mitral valve leaflet with severe mitral regurgitation. The patient developed cardiogenic shock; she had an intra-aortic balloon pump placed for afterload reduction and was taken to the operating room for an emergency mitral valve replacement. Her clinical status rapidly improved and she made a full recovery. As in this case, acute mitral regurgitation can present with sudden life-threatening respiratory failure and cardiogenic shock so prompt diagnosis is critical. This is often misdiagnosed as pneumonia or other respiratory illnesses. Awareness, early diagnosis, and treatment of this entity could provide significant morbidity and mortality benefits for patients.
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14
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Bernard S, Deferm S, Bertrand PB. Acute valvular emergencies. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:653-665. [PMID: 35912478 DOI: 10.1093/ehjacc/zuac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Acute valvular emergencies represent an important cause of cardiogenic shock. However, their clinical presentation and initial diagnostic testing are often non-specific, resulting in delayed diagnosis. Moreover, metabolic disarray or haemodynamic instability may result in too great a risk for emergent surgery. This review will focus on the aetiology, clinical presentation, diagnostic findings, and treatment options for patients presenting with native acute left-sided valvular emergencies. In addition to surgery, options for medical therapy, mechanical circulatory support, and novel percutaneous interventions are discussed.
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Affiliation(s)
- Samuel Bernard
- Department of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Sebastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
| | - Philippe B Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
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15
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Su WX, Qian XF, Jiang L, Wu YF, Liu J. Unilateral pulmonary oedema: a case report and literature review. J Int Med Res 2022; 50:3000605221093678. [PMID: 35466750 PMCID: PMC9047815 DOI: 10.1177/03000605221093678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute myocarditis is often secondary to an acute virus infection, which can be the first
manifestation of upper respiratory tract symptoms, followed by chest tightness, shortness
of breath, palpitations, chest pain and other non-specific symptoms. In severe cases, it
can quickly progress to serious complications such as heart failure, shock and respiratory
failure. Laboratory examinations can show an increase of myocardial injury markers,
infection and inflammatory indicators. Cardiac ultrasound can detect the weakening of the
myocardial contraction and valve regurgitation. On imaging, bilateral pulmonary oedema
demonstrates symmetrical infiltration along the hilum of lung, called the “butterfly
shadow”. This current case report describes a patient with unilateral pulmonary oedema
caused by myocarditis that was initially misdiagnosed and treated as pneumonia. The
patient was subsequently treated with the application of extracorporeal membrane
oxygenation and he made a full recovery. A review of this case highlights that when a
patient’s symptoms are not typical, a comprehensive examination and evaluation are
required to avoid incorrect treatment.
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Affiliation(s)
- Wei-Xue Su
- Department of Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xue-Feng Qian
- Department of Critical Care Medicine, Suzhou Municipal Hospital, Suzhou, Jiangsu Province, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yun-Fu Wu
- Department of Critical Care Medicine, Suzhou Municipal Hospital, Suzhou, Jiangsu Province, China
| | - Jun Liu
- Department of Critical Care Medicine, Xuanwu Hospital Capital Medical University, Beijing, China
- Department of Critical Care Medicine, Suzhou Municipal Hospital, Suzhou, Jiangsu Province, China
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16
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Abstract
The inherited connective tissue disorders (Marfan syndrome, Loeys-Dietz syndrome [LDS], and Ehlers-Danlos syndrome [EDS]) involve connective tissue of various organ systems. These pathologies share many common features, nonetheless compared to Marfan syndrome, LDS' cardiovascular manifestations tend to be more severe. In contrast, no association is reported between LDS and the presence of ectopia lentis. The EDS are currently classified into thirteen subtypes. There is substantial symptoms overlap between the EDS subtypes, and they are associated with an increased incidence of cardiovascular abnormalities, such as mitral valve prolapse and aortic dissection.
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17
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Girvin F, Toy D, Escalon J. A unique case of unilateral pulmonary edema from partial anomalous pulmonary venous return in conjunction with superior vena cava stenosis. Clin Imaging 2021; 79:110-112. [PMID: 33933823 DOI: 10.1016/j.clinimag.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/24/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
While PAPVR is most commonly an incidental finding on chest CT, a unique case is presented where PAPVR in conjunction with SVC stenosis resulted in chronic symptomatic asymmetric pulmonary edema. The case reflects an unusual anatomic cause of unilateral edema, as a combination of both congenital and subsequently acquired anatomic anomalies.
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Affiliation(s)
- Francis Girvin
- NewYork Presbyterian Weill Cornell Medical Center, Department of Radiology, Cardiothoracic Imaging Division, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Dennis Toy
- NewYork Presbyterian Weill Cornell Medical Center, Department of Radiology, Cardiothoracic Imaging Division, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Joanna Escalon
- NewYork Presbyterian Weill Cornell Medical Center, Department of Radiology, Cardiothoracic Imaging Division, 1300 York Avenue, New York, NY 10065, United States of America.
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18
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Saha S, Chong WH, Saha BK. Unilateral Diffuse Alveolar Hemorrhage Due to Selective Directionality of Mitral Regurgitant Jet in a Patient With Severe Aortic Stenosis. Cureus 2021; 13:e14714. [PMID: 34055553 PMCID: PMC8157819 DOI: 10.7759/cureus.14714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Diffuse alveolar hemorrhage (DAH) in cardiac diseases results from pulmonary capillary stress failure due to pulmonary venous hypertension. The most common cardiac causes of DAH are heart failure and mitral valvular disease. Patients typically manifest with hemoptysis, radiologic chest abnormalities, and anemia. The chest infiltrates are generally bilateral, similar to pulmonary edema. Rarely, the chest infiltrates can be unilateral, mimicking an infectious etiology. We present the case of an 88-year-old female with critical aortic stenosis, who presented with shortness of breath, unilateral right lung infiltrates, and mild leukocytosis. The patient was misdiagnosed with pneumonia as pulmonary edema or DAH was expected to be a bilateral finding on chest imaging. The patient deteriorated and DAH was eventually diagnosed by bronchoscopy.
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Affiliation(s)
- Santu Saha
- Internal Medicine, Bangladesh Medical College, Dhaka, BGD
| | - Woon H Chong
- Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, USA
| | - Biplab K Saha
- Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, USA
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19
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Predictors of in-hospital mortality in patients admitted to the emergency department with cardiogenic pulmonary edema. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.853237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Abstract
Diffuse alveolar hemorrhage (DAH) is a rare condition with reported mortality ranging between 20 and 100%. There are many etiologies of DAH. Cardiac diseases are likely underreported causes of DAH. Heart failure and mitral valve diseases are the most common cardiac causes of DAH. The DAH results from pulmonary venous hypertension leading to stress failure of the pulmonary capillaries. There is also a contribution of the bronchial circulation. The Alveolar-capillary membrane or blood-gas barrier is an extremely thin structure that allows rapid and passive diffusion of oxygen from the inhaled air to the pulmonary capillaries while preventing pulmonary edema and DAH with chronic elevation of the transmural hydrostatic pressure. The purpose of this manuscript is to inform the clinician about this rare cause of DAH, which may be overlooked unless specifically sought after. We also discuss the pathophysiologic aspects of DAH and the safety mechanisms in place to prevent such occurrences.
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21
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[Infiltrative lung disease of the right upper lobe]. Rev Mal Respir 2021; 38:304-307. [PMID: 33678443 DOI: 10.1016/j.rmr.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/04/2021] [Indexed: 11/21/2022]
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22
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Hirata K, Ishimine T, Nakayama I, Yagi N, Wake M, Takahashi T, Taniguchi N, Tengan T. Unilateral Left Pulmonary Edema Caused by Contained Rupture of the Ascending Aortic Dissection. Intern Med 2021; 60:751-753. [PMID: 33028775 PMCID: PMC7990645 DOI: 10.2169/internalmedicine.5750-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 11/06/2022] Open
Abstract
Unilateral pulmonary edema (UPE) is a rare entity and is usually associated with severe mitral regurgitation and more frequently occurs in the right lung. We herein report a case of unilateral left pulmonary edema caused by external compression of the right pulmonary artery and left pulmonary vein caused by the presence of hematoma due to type A acute aortic dissection (AAD), resulting in asymmetrically increased inflow and decreased outflow in the left pulmonary circulation. Physicians caring for patients with UPE should be aware that AAD leading to the external compression of the heart may be a possible underlying mechanism.
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Affiliation(s)
| | - Toru Ishimine
- Cardiovascular Surgery, Okinawa Chubu Hospital, Japan
| | | | - Nobuhito Yagi
- Division of Cardiology, Okinawa Chubu Hospital, Japan
| | - Minoru Wake
- Division of Cardiology, Okinawa Chubu Hospital, Japan
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23
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Park HJ, Park SH, Woo UT, Cho SY, Jeon WJ, Shin WJ. Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report. World J Clin Cases 2021; 9:1408-1415. [PMID: 33644209 PMCID: PMC7896690 DOI: 10.12998/wjcc.v9.i6.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/28/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations. Negative pressure in the lungs is created, resulting in negative pressure pulmonary edema (NPPE).
CASE SUMMARY A 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression. The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier. We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery. Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors, anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients.
CONCLUSION Because diffuse alveolar hemorrhage accompanied by NPPE can occur, anesthesiologists should take care not to induce airway irritation.
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Affiliation(s)
- Hyung Joon Park
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Seung Ho Park
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Un Tak Woo
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Sang Yun Cho
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Woo Jae Jeon
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
| | - Woo Jong Shin
- Department of Anesthesia and Pain Medicine, Hanyang University, Guri Hospital, Guri 11923, Gyeonggi-do, South Korea
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24
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Jiang X, Cheng X, Zhang W. Unilateral cardiogenic pulmonary edema caused by acute mitral valve prolapse: A case report. Medicine (Baltimore) 2021; 100:e24622. [PMID: 33607797 PMCID: PMC7899911 DOI: 10.1097/md.0000000000024622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/14/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Unilateral cardiogenic pulmonary edema is a rare disease. A common cause is mitral valve and asymmetrical blood regurgitation that is primarily directed toward the upper right pulmonary vein, causing mean capillary pressure to increase on the right side and leading to right pulmonary edema. PATIENT CONCERNS A 41-year-old man was diagnosed with pneumonia after presenting with a 2-day history of cough and shortness of breath. Computed tomography indicated right pulmonary edema. He was managed with noninvasive ventilation; however, his condition continued to deteriorate, and he was transferred to the intensive care unit after tracheal intubation. DIAGNOSIS Acute posterior mitral valve prolapses; unilateral cardiogenic pulmonary edema. INTERVENTION Emergency mitral valve replacement was performed. During the operation, 2 ruptures of the chordae tendineae in the P2 scallop of the posterior mitral valve were found, and a No. 29 St. Jude mechanical mitral valve was implanted. OUTCOMES Cardiotonic and diuretic drugs were administered postoperatively. Tracheal intubation was removed on day 7; the patient was transferred to the general ward on day 11 and discharged on day 23 postoperatively. LESSONS Unilateral cardiogenic pulmonary edema is easily misdiagnosed. Computed tomographic (CT) imaging presentation, brain natriuretic peptide, and cardiac color Doppler ultrasound can assist in determining a differential diagnosis. Early surgical treatment is recommended for patients with acute mitral valve prolapse.
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25
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Khanduri A, Anand U, Doss M, Lovett L. Severe acute mitral valve regurgitation in a COVID-19-infected patient. BMJ Case Rep 2021; 14:e239782. [PMID: 33462059 PMCID: PMC7813411 DOI: 10.1136/bcr-2020-239782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 12/28/2022] Open
Abstract
The ongoing SARS-CoV-2 (COVID-19) pandemic has presented many difficult and unique challenges to the medical community. We describe a case of a middle-aged COVID-19-positive man who presented with pulmonary oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. Later in the hospital course, his pulmonary oedema and respiratory failure worsened as result of severe acute mitral valve regurgitation secondary to direct valvular damage from COVID-19 infection. The patient underwent emergent surgical mitral valve replacement. Pathological evaluation of the damaged valve was confirmed to be secondary to COVID-19 infection. The histopathological findings were consistent with prior cardiopulmonary autopsy sections of patients with COVID-19 described in the literature as well as proposed theories regarding ACE2 receptor activity. This case highlights the potential of SARS-CoV-2 causing direct mitral valve damage resulting in severe mitral valve insufficiency with subsequent pulmonary oedema and respiratory failure.
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Affiliation(s)
- Ayesha Khanduri
- Graduate Medical Education, WellStar Health System, Marietta, Georgia, USA
| | - Usha Anand
- Graduate Medical Education, WellStar Health System, Marietta, Georgia, USA
| | - Maged Doss
- Graduate Medical Education, WellStar Health System, Marietta, Georgia, USA
| | - Louis Lovett
- Graduate Medical Education, WellStar Health System, Marietta, Georgia, USA
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26
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Unilateral pulmonary edema in acute aortic regurgitation: A complication of infective endocarditis. J Cardiol Cases 2021; 24:41-44. [PMID: 34257761 DOI: 10.1016/j.jccase.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022] Open
Abstract
Cardiogenic unilateral pulmonary edema (UPE) is an uncommon clinical entity and it represents just 2% of cardiogenic pulmonary edema with inclination for the right upper lobe and it is most commonly associated with severe mitral regurgitation. In our review, the literature does not include any UPE cases that are associated with severe aortic regurgitation (AR). Herein, we present a case with UPE, that includes a patient diagnosed with infective endocarditis who presented with shortness of breath. Initial chest imaging revealed UPE. Severe acute AR was diagnosed clinically and confirmed by echocardiogram, caused by vegetations on the non-coronary cusp of the aortic valve. The patient was transferred for emergent surgical intervention. This case underscores the importance of emergently evaluating valvular pathology to reduce the mortality rate that is associated with this condition. <Learning objective: In this study, we are highlighting the importance of having a high suspicion index to consider the diagnosis of unilateral pulmonary edema, as this condition is rare and hard to diagnose and carries a high mortality as well.>.
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27
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Mahdi M, Abbasi F, Mironova M, Gugnani M, Parang P. Acute Mitral Regurgitation: An Unusual Cause of Unilateral Pulmonary Consolidation. Cureus 2021; 13:e12707. [PMID: 33614314 PMCID: PMC7883524 DOI: 10.7759/cureus.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Unilateral pulmonary consolidation generally indicates infectious pneumonia. In this case report, we describe a patient with infective endocarditis and acute mitral valve regurgitation who developed acute unilateral pulmonary consolidation that resolved dramatically after mechanical ventilation and diuretic therapy. The prompt resolution of the consolidation with treatment suggests pulmonary edema. This case report highlights that rare conditions such as acute pulmonary edema should be considered in the differential diagnosis of patients who present with unilateral pulmonary consolidation to avoid delay in appropriate treatment.
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Affiliation(s)
- Mohammed Mahdi
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Fatemeh Abbasi
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Maria Mironova
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Manish Gugnani
- Pulmonary and Critical Care Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Pirouz Parang
- Cardiology, Capital Health Regional Medical Center, Trenton, USA
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28
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Nathani A, Jones C, Ghamande SA, Jones SF. Unilateral pulmonary edema and acute severe mitral regurgitation associated with operatively repaired aortic coarctation. Proc (Bayl Univ Med Cent) 2021; 34:289-290. [PMID: 33678966 DOI: 10.1080/08998280.2020.1860441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Cardiogenic pulmonary edema classically presents bilaterally and with a symmetric distribution. Occasionally, cardiogenic pulmonary edema can present unilaterally, which carries an independent risk for mortality, possibly due to the delayed diagnosis. The most common cardiogenic cause of unilateral pulmonary edema is acute mitral regurgitation, frequently described in the setting of acute coronary syndrome. Here we describe a case of unilateral pulmonary edema caused by acute mitral regurgitation outside the setting of acute coronary syndrome.
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Affiliation(s)
- Alireza Nathani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor Scott and White/Texas A&M University, Temple, Texas
| | - Clinton Jones
- Division of Internal Medicine, Department of Medicine, Baylor Scott and White/Texas A&M University, Temple, Texas
| | - Shekhar A Ghamande
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor Scott and White/Texas A&M University, Temple, Texas
| | - Shirley F Jones
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Baylor Scott and White/Texas A&M University, Temple, Texas
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29
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Stingo FE, Sallam T, Govindu R, Ammar H. It Is Not Pneumonia! A Case of Unilateral Pulmonary Edema. Am J Med 2021; 134:e38-e39. [PMID: 32712144 DOI: 10.1016/j.amjmed.2020.05.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Facundo E Stingo
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC
| | - Tariq Sallam
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC
| | - Rukma Govindu
- Internal Medicine Department, University of Texas Health Science Center at Houston, Houston
| | - Hussam Ammar
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC.
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30
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Tharimena S, R Naidu AV. Post-surgical unilateral left pulmonary edema after mitral valve replacement - A diagnostic challenge. Ann Card Anaesth 2020; 23:508-511. [PMID: 33109814 PMCID: PMC7879901 DOI: 10.4103/aca.aca_180_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Unilateral left pulmonary edema due to inadvertent surgical occlusion of left superior and inferior pulmonary veins is not only an exceedingly rare complication of mitral valve surgeries but also a diagnostic challenge in the postoperative recovery unit. Described here is a case of a 38-year-old male who developed progressively worsening unilateral left pulmonary edema after mitral valve replacement on postoperative day-1. The diagnosis was mostly by the exclusion of multiple possible differentials and was confirmed during reexploration surgery.
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Affiliation(s)
- Saipriya Tharimena
- Department of Cardiac Anaesthesia, Apollo Hospitals, Secunderabad, Hyderabad, Telangana, India
| | - A V R Naidu
- Department of Cardiac Anaesthesia, Apollo Hospitals, Secunderabad, Hyderabad, Telangana, India
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31
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Hardin CC, Malhotra R, Petranović M, Klassen S, Mihatov N, Oakley DH. Case 23-2019: A 52-Year-Old Man with Fever, Cough, and Hypoxemia. N Engl J Med 2019; 381:359-369. [PMID: 31340098 DOI: 10.1056/nejmcpc1900598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Charles C Hardin
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Rajeev Malhotra
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Milena Petranović
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Sheila Klassen
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Nino Mihatov
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Derek H Oakley
- From the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Medicine (C.C.H., R.M., S.K., N.M.), Radiology (M.P.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
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32
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Hamilton D, Lipscomb K. A man with fever and breathlessness. BMJ 2019; 364:l1085. [PMID: 30898856 DOI: 10.1136/bmj.l1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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33
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Balthazar T, Jacobs B, Voigt JU. Pulmonary vein signal in mitral regurgitation. Crit Care 2018; 22:123. [PMID: 29747648 PMCID: PMC5946452 DOI: 10.1186/s13054-018-2031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/06/2018] [Indexed: 11/10/2022] Open
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34
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Abstract
This article reviews the imaging manifestations of acute myocardial infarction (MI) on computed tomography (CT) accompanied by case examples and illustrations. This is preceded by a review of the pathophysiology of MI (acute and chronic), a summary of its clinical presentation, and a brief synopsis of the technical aspects of cardiac CT. Several examples of the appearance of acute MI and its complications are shown on routine and cardiac tailored CT, and a sample of the latest advances in imaging technique, including dual-energy CT, are introduced.
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Affiliation(s)
- Alastair Moore
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA.
| | - Harold Goerne
- Department of Radiology, Cardiovascular Imaging Service, IMSS Western National Medical Center, Belisario Dominguez 1000, Guadalajara, Jalisco 44340, Mexico; Cardiovascular Imaging Service, Imaging and Diagnosis Center (CID), Av. Americas 2016, Guadalajara, Jalisco 44610, Mexico
| | - Prabhakar Rajiah
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Yuki Tanabe
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Sachin Saboo
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
| | - Suhny Abbara
- Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
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35
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Handagala R, Ralapanawa U, Jayalath T. Unilateral pulmonary edema: a case report and review of the literature. J Med Case Rep 2018; 12:219. [PMID: 30103814 PMCID: PMC6090641 DOI: 10.1186/s13256-018-1739-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 06/06/2018] [Indexed: 12/26/2022] Open
Abstract
Background Unilateral pulmonary edema is an uncommon condition and is a rare clinical entity that is often misdiagnosed at the initial stages. In a majority of patients it occurs in the upper lobe of the right lung. There are many causes of unilateral pulmonary edema, but the commonest is the presence of a grade 3 mitral regurgitation. Due to its rare presentation, a high index of suspicion is required, and correct management is necessary to reduce the morbidity and mortality. Case presentation We present a case of right-sided unilateral pulmonary edema in an 86-year-old Sinhalese Sri Lankan woman who presented with acute onset dyspnea with cardiogenic shock due to acute non-ST elevation myocardial infarction, complicated with grade 3 mitral regurgitation. She had clinical features of heart failure and pulmonary edema, but a chest X-ray showed unilateral infiltrates only on the right side. Distinguishing pneumonia from pulmonary edema according to chest X-ray findings was a challenge initially, and she was therefore initially treated for both conditions. She had remarkable clinical and radiological improvement after 12 hours of intravenously administered furosemide and glyceryl trinitrate therapy. Her brain natriuretic peptide level was elevated and further supported and confirmed the diagnosis retrospectively. Conclusions Unilateral pulmonary edema is a completely reversible condition with good patient outcome if it is suspected early and treated early. Even in the absence of readily available echocardiogram skills, a clinical examination is of paramount importance in making a clinical decision in low-resource settings to reduce mortality.
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Affiliation(s)
| | - Udaya Ralapanawa
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
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36
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Thomas B, Durant E, Barbant S, Nagdev A. Repeat Point-of-Care Echocardiographic Evaluation of Traumatic Cardiac Arrest: A New Paradigm for the Emergency Physician. Clin Pract Cases Emerg Med 2018; 1:194-196. [PMID: 29849292 PMCID: PMC5965168 DOI: 10.5811/cpcem.2017.2.33021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/09/2017] [Accepted: 02/22/2017] [Indexed: 12/27/2022] Open
Abstract
We report a case of a 52-year-old man who presented to the emergency department (ED) in extremis (hypotensive with an altered sensorium) with subsequent cardiac arrest after a motor vehicle collision. The initial trauma evaluation did not reveal a source of the hemodynamic compromise. A point-of-care ultrasound revealed severe mitral regurgitation secondary to an anterolateral papillary muscle rupture. Patient underwent successful emergent mitral valve replacement after initial resuscitative efforts and intraaortic balloon pump placement.
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Affiliation(s)
- Benjamin Thomas
- Highland General Hospital, Department of Emergency Medicine, Oakland, California
| | - Edward Durant
- Highland General Hospital, Department of Emergency Medicine, Oakland, California
| | - Sophie Barbant
- Highland General Hospital, Department of Cardiology, Oakland, California
| | - Arun Nagdev
- Highland General Hospital, Department of Emergency Medicine, Oakland, California
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37
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Abstract
Acute MR is a rare but important etiology of unilateral pulmonary edema. Anterior leaflet flail can cause right upper lobe opacity. Early imaging with TTE can establish diagnosis and guide lifesaving intervention.
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Affiliation(s)
- Venkatesh Ravi
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois
| | - Jesus Rodriguez
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois
| | - Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois.,Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Nataliya Pyslar
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois
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Chacko J, Brar G, Mundlapudi B, Kumar P. Papillary Muscle Dysfunction Due to Coronary Slow-Flow Phenomenon Presenting with Acute Mitral Regurgitation and Unilateral Pulmonary Edema. Indian J Crit Care Med 2018; 22:806-808. [PMID: 30598569 PMCID: PMC6259443 DOI: 10.4103/ijccm.ijccm_343_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Cardiogenic pulmonary edema usually presents with characteristic clinical features and bilateral infiltrates on the chest radiograph. Rarely, pulmonary edema may manifest unilaterally, leading to a mistaken diagnosis of a primary lung pathology. We present a 30-year-old man who developed acute coronary syndrome following an overdose of alprazolam. He developed breathlessness with unilateral infiltrates on the chest radiograph. Echocardiography revealed regional wall motion abnormalities related to underlying ischemia and acute mitral regurgitation with an eccentric jet. Besides, he had significant impairment of left ventricular systolic function. His coronary angiogram revealed a slow-flow phenomenon in the right coronary and left anterior descending artery territories. Ischemia-related dysfunction of the posterolateral papillary muscle probably led to a floppy posterior mitral leaflet and an eccentrically directed regurgitant jet, leading to unilateral pulmonary edema. He was commenced on dual antiplatelet therapy, heparin infusion, atorvastatin, frusemide, and ramipril, following which he showed gradual clinical improvement along with resolution of the radiological infiltrates. His left ventricular function improved, and the mitral valve function normalized on echocardiography within a week.
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Affiliation(s)
- Jose Chacko
- Department of Critical Care Medicine, Narayana Multispecialty Hospital, Bengaluru, Karnataka, India
| | - Gagan Brar
- Department of Critical Care Medicine, Narayana Multispecialty Hospital, Bengaluru, Karnataka, India
| | - Bhargav Mundlapudi
- Department of Critical Care Medicine, Narayana Multispecialty Hospital, Bengaluru, Karnataka, India
| | - Pradeep Kumar
- Department of Critical Care Medicine, Narayana Multispecialty Hospital, Bengaluru, Karnataka, India
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Inotani S, Kubokawa SI, Nakaoka Y, Kotani T, Matsuda H, Yamamoto S, Seki SI, Kawai K, Hamashige N, Doi Y. Unilateral cardiogenic pulmonary edema. J Cardiol Cases 2017; 17:85-88. [PMID: 30279862 DOI: 10.1016/j.jccase.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022] Open
Abstract
A 45-year-old man presented with fatigue for the previous two days. Because of severe hypoxemia and chest radiograph showing severe consolidation only in the right lung field, he was admitted to a near-by district hospital under the diagnosis of acute pneumonia. Since his respiratory condition rapidly deteriorated, he was transferred to our hospital. The diagnosis of unilateral cardiogenic pulmonary edema was made based upon the echocardiographic examination which showed severe mitral regurgitation secondary to chordal rupture of the posterior mitral valve leaflet (P2). After successful intensive medical treatment with diuretics and extracorporeal membrane oxygenation, mitral valve repair was performed with quadrangular resection of the posterior mitral leaflet (P2) and insertion of 28 mm Cosgrove ring. It is important to recognize acute and severe mitral regurgitation as a main cause of unilateral cardiogenic pulmonary edema. Prompt differentiation from acute pneumonia is critical to save lives of the patients. <Learning objective: Unilateral cardiogenic pulmonary edema is an unusual condition and may often be misdiagnosed as acute pneumonia, resulting in an increased risk of mortality. A correct differentiation from pneumonia is critical to save lives of the patients. It is important to recognize acute and severe mitral regurgitation as a main cause of this unusual condition.>.
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Affiliation(s)
- Satoshi Inotani
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Sho-Ichi Kubokawa
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Yoko Nakaoka
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Toshiaki Kotani
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Hideyuki Matsuda
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Satoshi Yamamoto
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Shu-Ichi Seki
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Kazuya Kawai
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Naohisa Hamashige
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
| | - Yoshinori Doi
- The Department of Medicine & Cardiology, Chikamori Hospital, Kochi, Japan
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40
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Resciniti E, Caso I, Scarfò I, Pasquale GD, Canna GL. Unilateral Pulmonary Edema in a Patient with Worsening Tricuspid Valve Regurgitation: A Secret Inside Pulmonary Veins. J Cardiovasc Echogr 2017; 27:153-155. [PMID: 29142816 PMCID: PMC5672690 DOI: 10.4103/jcecho.jcecho_26_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We present the case of a 69-year-old patient who was referred to the Department of Echocardiography for surgical treatment of severe tricuspid valve regurgitation (TVR) with advanced congestive heart failure. In 2013 the patient underwent unsuccessful percutaneous ablation for permanent atrial fibrillation. In 2015, following numerous episodes of atrial fibrillation and congestive heart failure with left pleural effusion, the patient was admitted to another center. A transthoracic echocardiogram showed severe TVR and moderate precapillary pulmonary hypertension, confirmed at right cardiac catheterization. He showed bilateral ankle swelling, mild systolic cardiac murmur and localized leftmost decreased breath sounds. Chest X-ray revealed left-sided pulmonary edema and ipsilateral large pleural effusion. Following percutaneous drainage of the left pulmonary effusion, the patient underwent transthoracic and transesophageal echocardiography (TEE), confirming severe TVR due to annular dilation, severe pulmonary hypertension (60 mmHg) and right ventricular overload. At TEE, we found a narrowed single left pulmonary vein. Coronary artery angiography showed no critical stenosis. The patient underwent cardiac magnetic resonance and Angiography that confirmed ostial stenosis of a single left pulmonary vein. We performed successful bare-metal stent implantation. After the procedure, we observed progressive improvement in the patient's clinical condition, concomitant with reverse pulmonary hypertension, significant TVR reduction and chest X-ray normalization. This is a rare case of unilateral pulmonary edema following percutaneous ablation of atrial fibrillation.
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Affiliation(s)
| | - Ilaria Caso
- Department of Echocardiography, San Raffaele Hospital, Milan, Italy
| | - Iside Scarfò
- Department of Echocardiography, San Raffaele Hospital, Milan, Italy
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41
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Meester JAN, Verstraeten A, Schepers D, Alaerts M, Van Laer L, Loeys BL. Differences in manifestations of Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Ann Cardiothorac Surg 2017; 6:582-594. [PMID: 29270370 DOI: 10.21037/acs.2017.11.03] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many different heritable connective tissue disorders (HCTD) have been described over the past decades. These syndromes often affect the connective tissue of various organ systems, including heart, blood vessels, skin, joints, bone, eyes, and lungs. The discovery of these HCTD was followed by the identification of mutations in a wide range of genes encoding structural proteins, modifying enzymes, or components of the TGFβ-signaling pathway. Three typical examples of HCTD are Marfan syndrome (MFS), Ehlers-Danlos syndrome (EDS), and Loeys-Dietz syndrome (LDS). These syndromes show some degree of phenotypical overlap of cardiovascular, skeletal, and cutaneous features. MFS is typically characterized by cardiovascular, ocular, and skeletal manifestations and is caused by heterozygous mutations in FBN1, coding for the extracellular matrix (ECM) protein fibrillin-1. The most common cardiovascular phenotype involves aortic aneurysm and dissection at the sinuses of Valsalva. LDS is caused by mutations in TGBR1/2, SMAD2/3, or TGFB2/3, all coding for components of the TGFβ-signaling pathway. LDS can be distinguished from MFS by the unique presence of hypertelorism, bifid uvula or cleft palate, and widespread aortic and arterial aneurysm and tortuosity. Compared to MFS, LDS cardiovascular manifestations tend to be more severe. In contrast, no association is reported between LDS and the presence of ectopia lentis, a key distinguishing feature of MFS. Overlapping features between MFS and LDS include scoliosis, pes planus, anterior chest deformity, spontaneous pneumothorax, and dural ectasia. EDS refers to a group of clinically and genetically heterogeneous connective tissue disorders and all subtypes are characterized by variable abnormalities of skin, ligaments and joints, blood vessels, and internal organs. Typical presenting features include joint hypermobility, skin hyperextensibility, and tissue fragility. Up to one quarter of the EDS patients show aortic aneurysmal disease. The latest EDS nosology distinguishes 13 subtypes. Many phenotypic features show overlap between the different subtypes, which makes the clinical diagnosis rather difficult and highlights the importance of molecular diagnostic confirmation.
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Affiliation(s)
- Josephina A N Meester
- Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Aline Verstraeten
- Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Dorien Schepers
- Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Maaike Alaerts
- Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Lut Van Laer
- Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Bart L Loeys
- Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.,Department of Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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42
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Contou D, Voiriot G, Djibré M, Labbé V, Fartoukh M, Parrot A. Clinical Features of Patients with Diffuse Alveolar Hemorrhage due to Negative-Pressure Pulmonary Edema. Lung 2017; 195:477-487. [PMID: 28455784 DOI: 10.1007/s00408-017-0011-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Diffuse alveolar hemorrhage (DAH) with negative-pressure pulmonary edema (NPPE) is an uncommon yet life-threatening condition. We aimed at describing the circumstances, clinical, radiological, and bronchoscopic features, as well as the outcome of patients with NPPE-related DAH. METHODS We performed a retrospective, observational cohort study, using data prospectively collected over 35 years in an intensive care unit (ICU). RESULTS Of the 149 patients admitted for DAH, we identified 18 NPPE episodes in 15 patients, one admitted four times for recurrent NPPE-related DAH. The patients were primarily young, male, and athletic. The NPPE setting was postoperative (n = 12/18, 67%) or following generalized tonic-clonic seizures (n = 6/18, 33%). Hemoptysis was almost constant (n = 17/18, 94%), yet rarely massive (>200 cc, n = 1/18, 6%), with anemia observed in 10 (56%) episodes. The DAH triad (hemoptysis, anemia, and pulmonary infiltrates) was observed in 50% of episodes (n = 9/18), and acute respiratory failure in 94% (n = 17/18). Chest computed tomography revealed diffuse bilateral ground glass opacities (n = 10/10, 100%), while bronchoscopy detected bilateral hemorrhage (n = 12/12, 100%) and macroscopically bloody bronchoalveolar lavage, with siderophage absence in most (n = 7/8, 88%), indicating acute DAH. While one episode proved fatal, the other 17 recovered rapidly, with a mean ICU stay lasting 4.6 (2-15) days. Typically, the evolution was rapidly favorable under supportive care. CONCLUSION NPPE-related DAH is a rare life-threatening condition occurring primarily after tonic-clonic generalized seizure or generalized anesthesia. Clinical circumstances are a key to its diagnosis. Early diagnosis and recognition likely allow for successful management of this potentially serious complication, whereas ictal-DAH appears ominous in epileptic patients.
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Affiliation(s)
- Damien Contou
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. .,Réanimation Polyvalente, Hôpital Victor Dupouy, 69 Rue du Lieutenant Colonel Prudhon, 95100, Argenteuil, France.
| | - Guillaume Voiriot
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Michel Djibré
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Vincent Labbé
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Muriel Fartoukh
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Antoine Parrot
- Service de Réanimation médico-chirurgicale, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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43
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Hovnanians N, Alsara O, Mahmoud AN, Agarwal N, Mojaddedi S, Anderson RD, Mojadidi MK. Cardiac Pneumonia: Acute Mitral Regurgitation Causing Lobar Infiltrate. Am J Med 2017; 130:e147-e148. [PMID: 28325226 DOI: 10.1016/j.amjmed.2016.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022]
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44
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Bishara H, Saffuri A, Weiler-Ravell D. An 80-year-old man with a right upper lobe opacity. THE CLINICAL RESPIRATORY JOURNAL 2017; 11:126-129. [PMID: 25764123 DOI: 10.1111/crj.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/30/2014] [Accepted: 02/28/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIMS The differential diagnosis of a right upper lobe pulmonary opacity in an elderly afebrile patient includes infectious and malignant etiology. However, unilateral lung edema should also be included in the differential diagnosis. METHODS Case report of an 80-year-old afebrile patient who presented with cough, dyspnea and blood-tinged sputum and had an isolated right upper lobe infiltrate on chest X-ray on whom a diagnostic work-up including computed tomography scan of the chest and echocardiography was performed. RESULTS Bilateral alveolar opacities and pleural effusions, not apparent on the chest X-ray, and a flail posterior leaflet with severe mitral valve regurgitation were revealed. His symptoms and findings responded to diuretic treatment. CONCLUSION Pulmonary edema should be considered in a patient with mitral valve regurgitation presenting with a unilateral lung infiltrate. Chest computed tomography scan findings consistent with heart failure and echocardiography demonstrating mitral valve regurgitation are the main clues to the diagnosis. Diuretic therapy should cause a rapid improvement of the radiologic and clinical findings.
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Affiliation(s)
- Hashem Bishara
- Tuberculosis Clinic and Pulmonary Division, Nazareth Hospital, Faculty of Medicine, Galilee Bar-Ilan University, Nazareth, Israel
| | - Amer Saffuri
- Internal Medicine Department, Nazareth Hospital, Faculty of Medicine, Galilee Bar-Ilan University, Nazareth, Israel
| | - Daniel Weiler-Ravell
- Tuberculosis Clinic and Pulmonary Division, Nazareth Hospital, Faculty of Medicine, Galilee Bar-Ilan University, Nazareth, Israel
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45
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Cardiogenic unilateral pulmonary oedema in an infant with severe residual mitral regurgitation. Cardiol Young 2017; 27:173-175. [PMID: 27748226 DOI: 10.1017/s1047951116001372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An infant with residual severe mitral regurgitation following mitral commissurotomy developed cardiogenic unilateral pulmonary oedema and subsegmental atelectasis that resolved with mechanical mitral valve replacement.
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46
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Imaging of nontraumatic thoracic emergencies. Curr Opin Pulm Med 2016; 23:184-192. [PMID: 28009644 DOI: 10.1097/mcp.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Acute chest symptoms form an important incentive for imaging in the emergency setting. This review discusses the radiologic features of various vascular and pulmonary diseases leading to acute respiratory distress and recent developments on important emergency radiologic examinations. RECENT FINDINGS Recently, triple-rule-out computed tomography protocol was introduced in diagnosis of chest pain, and advancing computed tomography technology and knowledge have led to discussion on treatment of pulmonary embolism. Diffuse pulmonary opacities remain a diagnostic dilemma in the emergency setting and although imaging findings can often be nonspecific, they help in guiding toward accurate diagnosis and timely management. SUMMARY Though promising, triple-rule-out is not yet justified because of low incidence of additional findings compared with conventional computed tomography angiography in chest pain, but it might be suited for clinical practice in the near future. Relevance of isolated subsegmental pulmonary embolism is unknown and research on this topic is needed and on its way. We provided some key findings in differentiating diffuse pulmonary opacities and describe the additional value of chest ultrasound in this clinical dilemma. A brief sidestep to pneumothorax is made, as this is also a frequent finding in the acute dyspneic patient, as well as in patients with acute chest pain.
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47
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Koroscil M. Tumbling Downhill: Unilateral Pulmonary Edema. Am J Med 2016; 129:1054-6. [PMID: 27427322 DOI: 10.1016/j.amjmed.2016.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Matthew Koroscil
- Department of Internal Medicine, Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio.
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48
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Kashiura M, Tateishi K, Yokoyama T, Jujo M, Tanabe T, Sugiyama K, Akashi A, Hamabe Y. Unilateral cardiogenic pulmonary edema associated with acute mitral regurgitation. Acute Med Surg 2016; 4:119-122. [PMID: 29123847 PMCID: PMC5667298 DOI: 10.1002/ams2.234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/30/2016] [Indexed: 11/06/2022] Open
Abstract
Case Two cases of cardiogenic unilateral pulmonary edema are reported. Both patients presented to the emergency department with dyspnea, and chest radiography revealed unilateral infiltration, which mimics pulmonary disease. However, the patients were diagnosed with cardiogenic pulmonary edema, because echocardiography showed severe mitral regurgitation with an eccentric jet. Outcome The patients underwent mitral valve replacement and were discharged without complications. Conclusion Unilateral cardiogenic pulmonary edema is rare, and early diagnosis and treatment are difficult. Delayed treatment leads to high mortality. The major cause of unilateral pulmonary edema is acute mitral regurgitation, and the direction of the jet is suggested as a mechanism of laterality.
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Affiliation(s)
- Masahiro Kashiura
- Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Sumida-ku Tokyo Japan
| | - Kazuya Tateishi
- Department of Cardiology Tokyo Metropolitan Bokutoh Hospital Sumida-ku Tokyo Japan
| | - Taro Yokoyama
- Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Sumida-ku Tokyo Japan
| | - Mioko Jujo
- Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Sumida-ku Tokyo Japan
| | - Takahiro Tanabe
- Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Sumida-ku Tokyo Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Sumida-ku Tokyo Japan
| | - Akiko Akashi
- Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Sumida-ku Tokyo Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center Tokyo Metropolitan Bokutoh Hospital Sumida-ku Tokyo Japan
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49
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Muthalaly RG, Nasis A. Unilateral pulmonary oedema: A case report of a commonly missed and highly consequential condition. Int J Cardiol 2016; 207:62-3. [DOI: 10.1016/j.ijcard.2016.01.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
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50
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Figueras J, Bañeras J, Peña-Gil C, Barrabés JA, Rodriguez Palomares J, Garcia Dorado D. Hospital and 4-Year Mortality Predictors in Patients With Acute Pulmonary Edema With and Without Coronary Artery Disease. J Am Heart Assoc 2016; 5:e002581. [PMID: 26883921 PMCID: PMC4802455 DOI: 10.1161/jaha.115.002581] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term prognosis of acute pulmonary edema (APE) remains ill defined. METHODS AND RESULTS We evaluated demographic, echocardiographic, and angiographic data of 806 consecutive patients with APE with (CAD) and without coronary artery disease (non-CAD) admitted from 2000 to 2010. Differences between hospital and long-term mortality and its predictors were also assessed. CAD patients (n=638) were older and had higher incidence of diabetes and peripheral vascular disease than non-CAD (n=168), and lower ejection fraction. Hospital mortality was similar in both groups (26.5% vs 31.5%; P=0.169) but APE recurrence was higher in CAD patients (17.3% vs 6.5%; P<0.001). Age, admission systolic blood pressure, recurrence of APE, and need for inotropics or endotracheal intubation were the main independent predictors of hospital mortality. In contrast, overall mortality (70.0% vs 57.1%; P=0.002) and readmission for nonfatal heart failure after a 45-month follow-up (10-140; 17.3% vs 7.6%; P=0.009) were higher in CAD than in non-CAD patients. Age, peripheral vascular disease, and peak creatine kinase MB during index hospitalization, but not ejection fraction, were the main independent predictors of overall mortality, whereas coronary revascularization or valvular surgery were protective. These interventions were mostly performed during hospitalization index (294 of 307; 96%) and not intervened patients showed a higher risk profile. CONCLUSIONS Long-term mortality in APE is high and higher in CAD than in non-CAD patients. Considering the different in-hospital and long-term mortality predictors herein described, which do not necessarily involve systolic function, it is conceivable that a more aggressive interventional program might improve survival in high-risk patients.
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Affiliation(s)
- Jaume Figueras
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jordi Bañeras
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Carlos Peña-Gil
- Servicio de Cardiología, Complexo Hospitalario Universitario de Vigo, SERGAS, Vigo, Spain
| | - José A Barrabés
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jose Rodriguez Palomares
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - David Garcia Dorado
- Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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