1/3. Cardiac-pulmonary edema and low pulmonary capillary wedge pressure.We describe a patient who presented with acute massive pulmonary edema, clinically and on chest roentgenogram. Two hours later the patient became hypotensive and was found to have a low pulmonary capillary wedge pressure (PCWP). The blood pressure returned to normal after administration of fluids. Acute pulmonary edema develops if PCWP rises higher than 25 to 30 mm Hg. In our patient, the elevated PCWP fell to low normal within two hours, when chest roentgenogram and clinical examination still suggested severe pulmonary edema. A phase lag existed between lowering of the pulmonary capillary wedge pressure and clearing of fluid from the alveolar and interstitial spaces in the lungs. At least three different pathogenetic mechanisms in patients with coronary artery disease can produce this phase lag. Transient global ischemia of the left ventricle was thought to be the responsible mechanism in our patient.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/3. Idiopathic dilated cardiomyopathy.A 43-year-old man had a 9-year history of congestive heart failure manifested by an enlarged heart and symptoms of shortness of breath and chest discomfort. heart failure had been preceded by a "viral illness" and he had been a heavy alcohol user until that time. autopsy showed congestion and edema characteristic of heart failure and cardiomegaly with biventricular dilatation. Either viral or alcoholic disease, or both, could have been the cause of the cardiac problems.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
3/3. Idiopathic hydropericardium as a cause of death of a preterm neonate.We report a case of a very premature infant who died on day 17 of life because of clinically unsuspected cardiac tamponade due to a pericardial effusion with no gross or microscopic features of myocardial inflammation or perforation. The pericardial effusion probably accumulated for 8 days prior to his death, as evidenced by chest X-ray films. The only relevant microscopic finding was a prominent pericardial and myocardial interstitial edema. Although staphylococcus epidermidis line sepsis, central venous catheter trauma, hypoalbuminemia, anemia, and heart failure could be possible contributory factors, no definitive cause of the pericardial effusion was found and the etiology of this condition remains obscure.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |