Postpericardiotomy and Postmyocardial Infarction Syndrome (10)

On the third postoperative day; there was further deterioration with bilateral pulmonary edema and pleural effusions and a normal heart size on the chest roentgenogram. The Po2 was 41 mm Hg on 40 percent oxygen. No S3 gallop, JVD, heart murmur, or peripheral edema was observed.
By the fourth postoperative day, pulmonary edema had worsened. Because of unexplained pulmonary edema in the presence of good left ventricular function and the elevated sedimentation rate, an acute postpericardiotomy syndrome was considered. Accordingly, the patient was started on a regimen of prednisone 80 mg daily. Within 24 hours there was significant improvement and after 48 hours the Po2 was 62 mm Hg (94 percent saturation) on room air, and there was clearing of the pulmonary edema on chest roentgenogram.
The patient had an uneventful recovery. Steroid therapy was tapered and withdrawn over a six-week period. Three months later, the stress test showed no ischemia and a normal blood pressure response.
Summary
This patient had an anteroseptal infarct 17 days before coronary bypass surgery. Before surgery, ventricular function was normal, and the left atrial pressure was normal postoperatively. On the second postoperative day, however, progressive hypoxemia began to develop and the patient ultimately went into pulmonary edema without evidence of volume overload. There was no S3 gallop, JVD, or new murmur. The sedimentation rate rose to 117 mm/h. Dramatic improvement and recovery followed prednisone therapy.

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