1/7. Neurogenic pulmonary edema during intracranial endovascular therapy.Neurogenic pulmonary edema (NPE) is a well-known complication of acute brain injury. Neurogenic stunned myocardium (NSM) occurs clinically in a significant subset of patients with NPE. A 49-year-old woman developed refractory cerebral vasospasm requiring angioplasty following a subarachnoid hemorrhage. During angioplasty, NPE with NSM manifested as acute pulmonary edema associated with elevated pulmonary artery occlusion pressure and reduced cardiac output. Evaluations disclosed a right insular infarction, cardiac wall motion abnormalities, and electrocardiographic characteristics of NSM. The NSM completely resolved, and the neurological outcome was good. A 56-year-old woman developed NPE during complicated coil embolization of an internal carotid artery aneurysm. Cardiac function was normal, and the NPE resolved with a brief period of mechanical ventilation and diuresis. The delayed appearance of NSM and NPE during endovascular therapy in these patients implies a degree of risk for sympathetically mediated cardiopulmonary dysfunction during complex intracranial endovascular procedures.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. A case of myocardial damage following acute paracetamol poisoning.A 24-year-old woman was admitted to our hospital with acute paracetamol poisoning, and severe hepatic injury. The peak blood level of GOT, GPT and LDH were 32,600 U, 119,200 U and 36,500 U respectively. glucagon-insulin and glutathione were administered to save the liver function. On the third hospital day, hemodialysis was administered to treat acute renal failure. On the 16th hospital day, when the liver and renal functions recovered, severe pulmonary congestion occurred and right heart catheterization revealed high pulmonary pressure. echocardiography showed left ventricular enlargement accompanied by a severe diffuse impairment of left ventricular wall motion. Multi-focal ventricular arrhythmia was frequent during this period. Hemodialysis and artificial respiration were carried out for the treatment of heart failure. Three months after admission, myocardial perfusion scintigram showed patchy reduction in the uptake of Tl-201 throughout the myocardium, and left ventriculography showed mild diffuse impairment of the LV wall motion (ejection fraction: 49%). In this case, acute heart failure appeared approximately 2 weeks after the severe hepatic injury. Apparently myocardial damage following paracetamol overdosage is caused not only by direct toxicity but by severe metabolic derangement.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/7. Reversible left ventricular wall motion impairment caused by pheochromocytoma--a case report.Excessive catecholamine levels can cause myocardial damage in experimental animals. Similar observations have been made in humans following autopsy for pheochromocytoma. However, whether catecholamine crises are reversible or not remains uncertain. We report here a case in which pheochromocytoma manifested as acute pulmonary edema during an operation. Serial echocardiograms revealed that the depressed motion of the left ventricular wall was reversed after tumor removal. The plasma catecholamine level was extraordinarily high during the episode of acute pulmonary edema, and it seems that catecholamines in high concentration can directly damage the myocardium.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
4/7. Acute pulmonary edema provoked by psychologic stress. Report of two cases.Emotional stress has been considered responsible for life-threatening ventricular arrhythmias but acute stress-induced heart failure has not been reported in man. Two patients with recent uncomplicated myocardial infarction presenting acute pulmonary edema immediately after psychologic stress testing are the object of this report. Four stressors, mental arithmetic, 30 emotionally involving questions (Sacks' test modified), an image quiz (Raven's matrices) and white noise were administered during hemodynamic monitoring (Swan-Ganz catheter) in a 3-min stress-5-min recovery sequence. Response to the stressors was not unusual; greatest cardiovascular response occurred during mental arithmetic, least during noise and intermediate patterns were induced by the other stressors. heart rate and systemic blood pressure, markers of autonomic activation, increased moderately. Neither ventricular arrhythmias nor ischemic electrocardiographic changes were observed during or after stress testing. Complete recovery followed each stress-induced cardiovascular response. About 10 min after completing stress testing, acute pulmonary edema occurred in both patients neither of whom had presented other episodes of acute pulmonary edema, suggesting that psychologic stress may induce pump dysfunction in patients with latent heart failure.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
5/7. pulmonary edema associated with subarachnoid hemorrhage. Evidence for a cardiogenic origin.A 56-year-old woman with no history of cardiac disease developed acute pulmonary edema following a subarachnoid hemorrhage. A constellation of findings, including elevated creatine kinase MB isoenzyme activity in the absence of electrocardiographic or scintigraphic evidence of acute myocardial infarction, elevated pulmonary artery wedge pressure, segmental wall motion abnormalities, and depressed ejection fraction of the left ventricle demonstrated by two-dimensional echocardiography and radionuclear ventriculography, pointed to a direct myocardial injury leading to cardiac failure. The evidence for cardiogenic origin of pulmonary edema provided by this case is in contrast to the belief that "neurogenic" pulmonary edema is of noncardiac origin.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/7. pulmonary edema due to obstructive sleep apnea.Many cardiorespiratory problems have been identified in patients with sleep apnea syndrome. Acute pulmonary edema as the primary feature of obstructive sleep apnea has recently been reported, and is thought to be caused by the effects of severe hypoxemia and/or extreme negative intrathoracic pressure. We have described another patient with sleep apnea syndrome who had pulmonary edema on at least three different occasions. Extremely high pulmonary artery pressure, paradoxic motion of the interventricular septum, and very low right heart ejection fraction were found. The paradoxic septal motion disappeared and the right heart ejection fraction increased after tracheostomy.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
7/7. Postoperative acute pulmonary edema: a rare presentation of pheochromocytoma.A 39-year-old white female underwent an uneventful vaginal hysterectomy for dysfunctional bleeding. Evaluating a mild aortic insufficiency murmur preoperatively an echocardiogram revealed normal left ventricular wall motion and function. Postoperatively the patient developed severe abdominal pain, acute hypertension (200/100 mmHg), and sinus tachycardia. Within minutes she decompensated into acute pulmonary edema. ECG demonstrated acute ST segment elevation in the precordial leads consistent with acute infarction. Emergency left heart catheterization showed normal coronary vessels with severe left ventricular dysfunction. An abdominal ultrasound was obtained, revealing a right adrenal mass. plasma epinephrine was 334, norepinephrine 34,543 pg/ml; urine epinephrine 45, urine norepinephrine 2,137 micrograms/24 hours. She was started on prazosin and nifedipine sustained release with good blood pressure control. Four days later, an echocardiogram demonstrated the left ventricular wall motion reverting to normal. The adrenal tumor was subsequently resected successfully. Acute pulmonary edema causing dilated cardiomyopathy is a rare complication of pheochromocytoma that has been seldomly reported. A progressive fatal course is common: reversibility and survival depend on identifying and removing the pheochromocytoma.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |