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

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ABSTRACT

Patient: female, 35"/>

Echocardiography image taken at two-month follow-up showing normal left ventricular apex.
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f2-amjcaserep-17-682: Echocardiography image taken at two-month follow-up showing normal left ventricular apex.

Mentions: Fetal bradycardia ensued, which was persistent, and the patient was transferred to the operating room for an emergent cesarean section. A continuous propofol infusion at a rate of 25 µg/kg/min, which was started soon after intubation, was continued for providing anesthesia for the surgery. She received IV midazolam 2 mg at the start of the surgery. Neuromuscular blockade was achieved with IV rocuronium 50 mg. Norepinephrine infusion was continued throughout the surgery. A viable 25-week-old baby was delivered and sent to the neonatal intensive care unit (NICU) after being intubated for poor respiratory effort. The baby’s APGAR scores at 1 minute, 5 minutes, and 10 minutes were 1, 5, and 6, respectively. The mother was transferred to the surgical intensive care unit (SICU) with the norepinephrine infusion maintained and mechanical ventilation with a FiO2 of 100%. In the SICU, the norepinephrine was weaned off over the next 8 hours; she had a dramatic improvement in her cardiovascular and respiratory status over the next 24 hours. Her oxygen requirements decreased from a FiO2 of 100% at admission to the SICU to 40% the next morning, and she was extubated after meeting the necessary criteria. Her EF improved to 45% on the next ECHO examination performed 48 hours later. Her troponin levels at 6 hours and 12 hours after admission were 2.550 ng/mL and 1.540 ng/mL (normal value 0–0.120 ng/mL), respectively. In view of significant improvement in the patient’s clinical status and left ventricular function, it was decided not to pursue cardiac catheterization. She received around-the-clock diuresis with intravenous furosemide titrated for clinical response and blood pressure control with a combination of oral hydralazine and labetalol to target systolic blood pressures (SBPs) less than 160 mm Hg over the next few days. She was discharged home after six days of hospital stay on oral carvedilol 25 mg twice a day and lisinopril 10 mg once a day. A follow-up ECHO was performed six weeks after delivery, showing an ejection fraction of 65% (Figure 2), and her workup for viral myocarditis, including serological testing, was negative.


Acute Pulmonary Edema in an Eclamptic Pregnant Patient: A Rare Case of Takotsubo Syndrome
Echocardiography image taken at two-month follow-up showing normal left ventricular apex.
© Copyright Policy
Related In: Results  -  Collection

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

f2-amjcaserep-17-682: Echocardiography image taken at two-month follow-up showing normal left ventricular apex.
Mentions: Fetal bradycardia ensued, which was persistent, and the patient was transferred to the operating room for an emergent cesarean section. A continuous propofol infusion at a rate of 25 µg/kg/min, which was started soon after intubation, was continued for providing anesthesia for the surgery. She received IV midazolam 2 mg at the start of the surgery. Neuromuscular blockade was achieved with IV rocuronium 50 mg. Norepinephrine infusion was continued throughout the surgery. A viable 25-week-old baby was delivered and sent to the neonatal intensive care unit (NICU) after being intubated for poor respiratory effort. The baby’s APGAR scores at 1 minute, 5 minutes, and 10 minutes were 1, 5, and 6, respectively. The mother was transferred to the surgical intensive care unit (SICU) with the norepinephrine infusion maintained and mechanical ventilation with a FiO2 of 100%. In the SICU, the norepinephrine was weaned off over the next 8 hours; she had a dramatic improvement in her cardiovascular and respiratory status over the next 24 hours. Her oxygen requirements decreased from a FiO2 of 100% at admission to the SICU to 40% the next morning, and she was extubated after meeting the necessary criteria. Her EF improved to 45% on the next ECHO examination performed 48 hours later. Her troponin levels at 6 hours and 12 hours after admission were 2.550 ng/mL and 1.540 ng/mL (normal value 0–0.120 ng/mL), respectively. In view of significant improvement in the patient’s clinical status and left ventricular function, it was decided not to pursue cardiac catheterization. She received around-the-clock diuresis with intravenous furosemide titrated for clinical response and blood pressure control with a combination of oral hydralazine and labetalol to target systolic blood pressures (SBPs) less than 160 mm Hg over the next few days. She was discharged home after six days of hospital stay on oral carvedilol 25 mg twice a day and lisinopril 10 mg once a day. A follow-up ECHO was performed six weeks after delivery, showing an ejection fraction of 65% (Figure 2), and her workup for viral myocarditis, including serological testing, was negative.

View Article: PubMed Central - PubMed

ABSTRACT

Patient: female, 35"/>