Limits...
Acute Pulmonary Edema in an Eclamptic Pregnant Patient: A Rare Case of Takotsubo Syndrome

View Article: PubMed Central - PubMed

ABSTRACT

Patient: female, 35"/>

Echocardiography image on admission showing dilated left ventricular apex.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC5036377&req=5

f1-amjcaserep-17-682: Echocardiography image on admission showing dilated left ventricular apex.

Mentions: A 35-year-old G2P1 female, weighing 120 kg with a body mass index (BMI) of 47 kg/m2, presented to the emergency department after having an episode of seizure at home and another episode in the ambulance. On admission, she was hypertensive with a blood pressure of 196/133 mm Hg and a heart rate of 154 bpm with occasional episodes of agitation. The husband denied any history of seizures and indicated that they had recently found out that the patient was pregnant, and they were scheduled for their first antenatal appointment in a few days. Her past medical history was insignificant, and her past surgical history was significant for an uneventful cholecystectomy. A computed tomography scan of the head was normal. Chest X-ray revealed pulmonary edema, and an echocardiogram (ECHO) revealed an ejection fraction (EF) of 25% with severe akinesia, ballooning of the apex, and excellent function in the inferolateral base (Figure 1). The patient’s electrocardiogram (EKG) on admission revealed sinus tachycardia with non-specific ST-T changes with no ST elevations. Her laboratory work was significant for a positive urine pregnancy test, leukocytosis, and proteinuria detected on spot urine test. Her initial troponin I value on admission was 2.650 ng/mL (normal range 0–0.120 ng/mL). The fetus had an estimated gestational age of 25 weeks 5 days and a normal heart rate detected by Doppler. The patient received 4 g of IV magnesium sulphate along with a loading dose of IV phenytoin (20 mg/kg) for seizure control. Over the next hour, she became tachypneic with the respiratory rate in the 40s and hypoxemic, with a PaO2 of 52 mm Hg on a Venturi mask with FiO2 of 80%, and required an emergent intubation. The endotracheal intubation with a size 7.5 mm oral tube was uneventful and was followed by severe, persistent hypotension. Norepinephrine infusion was initiated and titrated to maintain the mean blood pressure (MAP) higher than 65 mm Hg.


Acute Pulmonary Edema in an Eclamptic Pregnant Patient: A Rare Case of Takotsubo Syndrome
Echocardiography image on admission showing dilated left ventricular apex.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5036377&req=5

f1-amjcaserep-17-682: Echocardiography image on admission showing dilated left ventricular apex.
Mentions: A 35-year-old G2P1 female, weighing 120 kg with a body mass index (BMI) of 47 kg/m2, presented to the emergency department after having an episode of seizure at home and another episode in the ambulance. On admission, she was hypertensive with a blood pressure of 196/133 mm Hg and a heart rate of 154 bpm with occasional episodes of agitation. The husband denied any history of seizures and indicated that they had recently found out that the patient was pregnant, and they were scheduled for their first antenatal appointment in a few days. Her past medical history was insignificant, and her past surgical history was significant for an uneventful cholecystectomy. A computed tomography scan of the head was normal. Chest X-ray revealed pulmonary edema, and an echocardiogram (ECHO) revealed an ejection fraction (EF) of 25% with severe akinesia, ballooning of the apex, and excellent function in the inferolateral base (Figure 1). The patient’s electrocardiogram (EKG) on admission revealed sinus tachycardia with non-specific ST-T changes with no ST elevations. Her laboratory work was significant for a positive urine pregnancy test, leukocytosis, and proteinuria detected on spot urine test. Her initial troponin I value on admission was 2.650 ng/mL (normal range 0–0.120 ng/mL). The fetus had an estimated gestational age of 25 weeks 5 days and a normal heart rate detected by Doppler. The patient received 4 g of IV magnesium sulphate along with a loading dose of IV phenytoin (20 mg/kg) for seizure control. Over the next hour, she became tachypneic with the respiratory rate in the 40s and hypoxemic, with a PaO2 of 52 mm Hg on a Venturi mask with FiO2 of 80%, and required an emergent intubation. The endotracheal intubation with a size 7.5 mm oral tube was uneventful and was followed by severe, persistent hypotension. Norepinephrine infusion was initiated and titrated to maintain the mean blood pressure (MAP) higher than 65 mm Hg.

View Article: PubMed Central - PubMed

ABSTRACT

Patient: female, 35"/>