Acute diastolic dysfunction due to pneumomediastinum following positive end-expiratory pressure--a case report.
A 78-year-old woman was admitted for pulmonary embolism requiring orotracheal intubation and positive end-expiratory pressure. The pulmonary angiography confirmed a massive pulmonary embolism as suggested by echocardiography. Heparin and recombinant tissue plasminogen activator were successfully administrated; nevertheless, cardiogenic shock developed. A diastolic morphology of the right-left cardiac pressures, despite a normalization of lung vasculature, was discovered by a repeated cardiac catheterization and pulmonary angiography. No tamponade was detected by echocardiography. Computed tomography demonstrated a large pneumomediastinum caused by positive end-expiration pressure, as a cause of the acute diastolic dysfunction. The patient died of a cardiac arrest after an unsuccessful drainage attempt.
Rigatelli
Gianluca
G
Department of Cardiovascular Disease, Cittadella Civic Hospital, Padua, Italy. emodinacit@ulss15.pd.it
Zanchetta
Mario
M
Pedon
Luigi
L
Zennaro
Marco
M
Maiolino
Pietro
P
D000208:Acute Disease; D000368:Aged; D003971:Diastole / Q000502:physiology; D005260:Female; D006323:Heart Arrest / Q000209:etiology*; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008478:Mediastinal Emphysema / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011175:Positive-Pressure Respiration / Q000009:adverse effects*