Adenosine
- PDF / 152,105 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 67 Downloads / 152 Views
1 S
Acute hypoxemic hypercapnic respiratory failure: case report. A 62-year-old man developed acute hypoxemic hypercapnic respiratory failure during treatment with adenosine for non-ST elevation myocardial infarction (NSTEMI). The man, who had a history of hypothyroidism, coronary artery disease and chronic obstructive airways disease presented with a complaint of onset of sudden retrosternal chest discomfort and was diagnosed with NSTEMI. An ECG revealed 45% left ventricular ejection fraction (LVEF) and a regional wall motion abnormality. He was an active smoker. A coronary angiography demonstrated diseased proximal to mid right coronary artery (RCA) with patent distal RCA stent. Subsequently, he underwent percutaneous coronary intervention with two sirolimus eluting cobalt chromium stent placement. Despite successful treatment to the right coronary lesion, his thrombolysis in myocardial infarction (TIMI) score was 75 with TIMI II flow. Therefore, he received IC adenosine boluses through a catheter (total 300µg). Following the administration of adenosine, he developed dyspnoea, chest discomfort, respiratory rate elevated to 32 /minute and oxygen saturation dropped to 75% despite high oxygen flow. In order to maintain adequate oxygen, the man underwent a non-invasive ventilation following administration of morphine and furosemide. Despite achieving TIMI III flow and resolution of slow flow, the respiratory distress persisted. His arterial blood gas (ABG) pH was 7.339, partial pressure of carbon dioxide 59.8, partial pressure of oxygen 52.8, bicarbonate 31.3 and lactate 1.4. He was diagnosed with acute hypoxemic hypercapnic respiratory failure (type II). He was electively intubated on mechanical ventilator. An ECG was unremarkable. The NT-pro brain natriuretic peptide was 123 pg/mL. He was treated with hydrocortisone following nebulisation with bromide/budesonide and ipratropium-bromide/salbutamol [salbutamol/ipratropium]. In the next day morning, he was weaned off the mechanical ventilator and his ABG parameters improved. He was extubated and discharged with clopidogrel, ecospirin, rosuvastatin, prednisolone, budesonide/formoterol [formoterol fumarate/budesonide], levosalbutamol/ipratropiumbromide [levosalbutamol/ipratropium] and nicotine patch. Chaudhary R, et al. The curious case of slow flow, adenosine and respiratory failure. IHJ Cardiovascular Case Reports (CVCR) 4: 24-25, No. 1, Apr 2020. Available from: 803498308 URL: http://doi.org/10.1016/j.ihjccr.2020.05.004
0114-9954/20/1819-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 29 Aug 2020 No. 1819
Data Loading...
