A 36-year-old woman with a 10-week pregnancy was admitted to the Intensive Care Unit of the Clínica Reñaca due to severe acute pulmonary edema.
His symptoms began suddenly with dyspnea associated with rapid arousals, while nothing remained on a beach.
The patient was initially treated in a local hospital, receiving oxygen and intravenous furosemide, and then quickly transferred to our clinic.
On admission, the patient was very dyspneic (50 breaths/min), with cyanotic and wet skin, gallop rhythm on cardiac auscultation and signs of pulmonary congestion in both lung fields.
His blood pressure was 155 mmHg and his axillary temperature was 37.7°C.
A chest X-ray showed bilateral diffuse pulmonary edema with normal cardiac silhouette.
The electrocardiogram showed sinus tachycardia with a heart rate of 146 beats/min, with no signs of ischemia.
In a bidimensional echocardiogram and color Doppler, the left ventricle of normal size, hyperkinetic and without segmental changes in contraction or valvular heart disease was observed.
Two months before the present hospitalization, she had been diagnosed with a pregnancy and one year before the patient had had a normal delivery.
Contemporary to the diagnosis of pregnancy, the patient had begun to present intolerance to heat, itching and fatigue.
There was no history of heart disease or coronary risk factors such as hypertension, smoking or dyslipidemia, nor family history of heart disease.
The patient had been taking drugs or alcohol.
In the laboratory stood out: arterial gases (FiO2 0.50): 02 81 mmHg; pH 7.39; saturation 92%; leukocytosis 20.900 with 89% neutrophils.
Plasma phosphorus, magnesium, sodium, potassium and chlorine, cardiac and hepatic enzymes were normal.
Gynecologic ultrasound confirmed a 10-week pregnancy with a normal fetus.
The patient was treated with furosemide and aminophylline iv, subcutaneous morphine and sublingual isosorbide, with rapid relief of symptoms.
The next day, the patient maintained a tachypnea of 24 breaths/min, without respiratory distress.
Cardiac auscultation revealed mild tachycardia but no ventricular gallop.
Our diagnostic hypothesis was hyperthyroidism, although the thyroid was not palpable.
The diagnosis was confirmed with plasmatic thyroxine 52.4 Lig/dL (normal range: 4.5 to 12.0 μg/dL), triiodothyronine 3.6 ng/ml (normal range: TSH-2.0 ng/mL).
We started treatment with propranol 60 mg/day and propiltiouracil 600 mg/day.
On the seventh day, the patient was discharged, asymptomatic and with normal chest X-ray.
