Fatal case of amiodarone-induced acute respiratory distress syndrome in a patient with severe left ventricular dysfunction due to extensive anterior acute myocardial infarction.
We here report a case of 71-year-old man with acute extensive anterior myocardial infarction, who was complicated with ventricular tachycardia (VT) even after successful percutaneous coronary intervention. As intravenous administration of nifekalant terminated VT, we started oral administration of amiodarone (day 1). We gave 400 mg of amiodarone a day for the first week and 200 mg a day from the second week. The patient was stable with normoxia by day 20, in spite of pulmonary congestion-like infiltrates on chest X-ray. On day 21, he was complicated with acute respiratory distress syndrome. Immediate discontinuance of amiodarone and high-dose pulse glucocorticoid therapy with intubation slightly improved the infiltrations on chest X-ray. However, glucocorticoid therapy induced hyperglycemia with an increase in plasma osmolality, complicated with hypoalbuminemia, and gastrointestinal bleeding. Despite treatment with a large amount of saline, high-doses of catecholamines, and blood transfusion, the patient died on day 28. It is sometimes difficult to diagnose congestive heart failure or amiodarone-induced pulmonary infiltrates in patients with severe left ventricular dysfunction.
Fukumoto
Yoshihiro
Y
Division of Cardiovascular Medicine, Aso-Iizuka Hospital, Fukuoka, Japan. yofukumoto-circ@umin.ac.jp
Yamada
Akira
A
Ando
Hiroshi
H
Sobashima
Atsushi
A
Kuwata
Koichi
K
Yamawaki
Tohru
T
Nakamura
Ryo
R
Eto
Yasuhiro
Y
Kishi
Takuya
T
Ikeuchi
Masaki
M
Sekiya
Masatoshi
M
Ozawa
Makito
M
Okamatsu
Shuichi
S
D000368:Aged; D000638:Amiodarone / Q000009:adverse effects* / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000139:chemically induced*; D012720:Severity of Illness Index; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone