title: Cardiopulmonary manifestations of hantavirus pulmonary syndrome.
abstract: OBJECTIVE
  To describe the clinical characteristics of a group of patients infected with the newly recognized hantavirus in the Southwestern United States.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  All patients with confirmed hantavirus infection admitted to the University of New Mexico Hospital between May 1, 1993 and January 1, 1994.
  
  
  METHODS
  Records of patients with hantavirus infection were reviewed to collect all pertinent clinical data.
  
  
  RESULTS
  Pulmonary disease in these patients was characterized by hypoxemia covering a wide range of severity. The cause of hypoxemia was an increased permeability (noncardiac) pulmonary edema which could be differentiated from hydrostatic (cardiac) pulmonary edema by its association with low pulmonary artery occlusion pressures and increased protein content of edema fluid. Hemodynamic measurements in severe cases showed a shock state characterized by a low cardiac index (range 1.6 to 3.0 L/min/min2), a low stroke volume index (range 10.5 to 29 mL/m2), and high systemic vascular resistance index (range 1,653 to 2,997 dyne.sec/cm5.m2). Progression to death was associated with worsening cardiac dysfunction unresponsive to treatment and causing oxygen debt and lactic acidosis.
  
  
  CONCLUSIONS
  The two major life-threatening pathophysiologic changes in Hantavirus Pulmonary Syndrome are increased permeability pulmonary edema, and an atypical form of septic shock caused by myocardial depression and hypovolemia.
authors.affiliation: Department of Medicine, University of New Mexico Hospital, Albuquerque 87131, USA.
authors.forename: G W
authors.initials: GW
authors.lastname: Hallin
authors.forename: S Q
authors.initials: SQ
authors.lastname: Simpson
authors.forename: R E
authors.initials: RE
authors.lastname: Crowell
authors.forename: D S
authors.initials: DS
authors.lastname: James
authors.forename: F T
authors.initials: FT
authors.lastname: Koster
authors.forename: G J
authors.initials: GJ
authors.lastname: Mertz
authors.forename: H
authors.initials: H
authors.lastname: Levy
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D005260:Female; D018804:Hantavirus Pulmonary Syndrome / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000821:virology; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000821:virology*; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000821:virology*; D015996:Survival Rate