Postpericardiotomy and Postmyocardial Infarction Syndrome (7)

Postpericardiotomy and Postmyocardial Infarction Syndrome (7)Because of pulmonary edema in the presence of apparent good left ventricular function (left arterial pressure, 7 to 13; PAD, 12 to 16), methylprednisolone 125 mg IV every 12 hours and prednisone 80 mg daily were given empirically. By the following morning, there was dramatic improvement with Po2 increasing to 74. Within 48 hours after the patient received steroids, the Po2 had risen to 75 with a saturation of 95 percent on 40 percent oxygen by face mask. The chest roentgenogram showed gradual improvement and clearing over a four-day period. The patient continued to do well, steroid therapy was gradually weaned prior to hospital discharge, and the patient had an uneventful recovery. Results of subsequent stress testing were normal.
Summary
A patient with normal left ventricular function underwent a second coronary artery bypass operation. There were no apparent perioperative problems. At 48 hours, however, she developed unexplained pulmonary edema and severe hypoxemia in the presence of normal left atrial and PAD pressures, and without any clinical findings of congestive heart failure. Her condition deteriorated despite increasing the oxygen delivery and receiving diuretics. There was prompt improvement following the administration of corticosteroids and subsequent recovery.

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