A 60-year-old woman with a history of recurrent pulmonary embolism, oral anticoagulant therapy suspended one year earlier, inferior vena cava filter installed 11 months earlier, hypertension and morbid obesity.
Aspirin user, clonazepam, citalo and atenolol were replaced one day prior to the current situation by losartan associated with hydrochlorothiazide.
The patient had a history of sudden dyspnea and dizziness, which was not well documented in 2002, in relation to a single intake of hydrochlorothiazide.
She presented with a three-day history of dry cough, progressive dyspnea, no chest pain, vomiting, or fever.
Upon admission, the patient was polypneic at 30 x’, cyanotic, hypotensive / 50 mmHg), HR 80 x’, T 36.5°C, drowsiness, it was decided to intubate the superficial ICU a
Physical examination: pulmonary murmur was decreased in both fields with abundant bilateral crypts, cardiac examination was normal, without murmurs.
The rest of the examination showed no significant alterations.
Blood gases at admission with an FiO2 of 100% showed pH 7.35, pCO2 33.1 mmHg, PaO2 85.9 mEq, HCO2 85.9 mEq.
Blood count: hematocrit 52.5%, white count 3900 mm3.
The rest of the laboratory tests showed no alterations.
Electrocardiogram: sinus tachycardia 120 x’, with no evidence of ischemia, admission troponin I 0.02 ng/ml.
Chest radiography was compatible with pulmonary edema.
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Swan-Ganz catheter was installed, which showed cardiac expenses between 6 and 7 L/min, PCP always below 18 mmHg, normal systemic vascular resistance and high pulmonary artery pressures.
Chest computed tomography angiography 6 h after admission was negative for tuberculosis.
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The patient was successfully treated with oxygen and rapidly declining requirements. She was discharged 24 h later and the Swan-Ganz catheter was removed 36 h later.
A new chest X-ray showed no pulmonary alveolar infiltrates.
An echocardiogram at 24 h of admission showed a preserved systolic function with an undilated left ventricle, with mild diastolic dysfunction type relaxation defect, a systolic pulmonary artery pressure (PSAP)cus of 40 mmHg and mild regurgitation.
NT-pro-BNP measurements (which range is lower than pg/ml for women older than 50 years) showed double normal values, being monitored for two days.
Admission value: 463 pg/mL and the next day 488.5 pg/mL.
On the seventh day of evolution, normal value was obtained: 74 pg/ml.
