Dipyridamole
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Shock and pulmonary oedema in an elderly patient: case report A 73-year-old woman developed shock and pulmonary oedema after dipyridamole used for myocardial scintigraphy. The woman, who had a history of coronary artery disease, ischaemic cardiomyopathy, congestive heart failure and implantable cardioverter defibrillator insertion, presented for dipyridamole/rubidium chloride positron emission tomography (PET) imaging. In about 6 minutes after completion of IV infusion of dipyridamole 0.57 mg/kg administered over 4 minutes, she developed dyspnoea, wheezing and hypoxaemia. The PET procedure was stopped and the woman was administered aminophylline. However, she rapidly deteriorated and was given atropine, epinephrine and was intubated on her transfer to the emergency department. Investigations on admission showed a HR of 110 beats/min, a BP of 190/100 mm Hg and a RR of >30 breaths/min on a ventilator. She had continuous pink foamy secretions from her endotracheal tube. Her lung auscultation revealed diffuse gurgling sounds and a chest radiograph detected dense infiltrates in the lungs. She was given furosemide, nitroglycerin and dobutamine, but continued to deteriorate and required cardiopulmonary resuscitation. A single dose of epinephrine was administered and pulses returned. She then received hydrocortisone, phenylephrine, norepinephrine, epinephrine and famotidine and improved over the next 12 hours. Twelve hours after developing refractory shock/hypoxaemia, she was extubated and discharged on hospital day 5, with no new cardiovascular or neurological complications. Author comment: "Use of the Naranjo probability scale suggested a probable relationship between dipyridamole and the complications." Dioverti M, et al. Dipyridamole-associated shock and pulmonary edema. Annals of Pharmacotherapy 45: e42, No. 7-8, Jul-Aug 2011. Available from: URL: http:// 803060262 dx.doi.org/10.1345/aph.1p734 - USA
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Reactions 24 Sep 2011 No. 1370
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