Key result
High-dose IV nitroglycerin stabilizes SCAPE within ~8 hours in suspected COVID-19.
Why the study?
The management and prognostication of sympathetic crashing acute pulmonary edema in elderly patients with Yasser's fibrillation, multiple valvular disease, possible multivessel disease, and COVID-19 pneumonia are complex and not well described.
Case Report (n=1)
No
A complex case of sympathetic crashing acute pulmonary edema with multiple concomitant cardiovascular morbidities and suspected COVID-19 pneumonia can be successfully managed with intensive, multidisciplinary medical therapy.
May support high-dose nitroglycerin in elderly SCAPE; single case leaves open need for prospective validation.
RationaleSympathetic crashing acute pulmonary edema is acute pulmonary edema often present with marked hypertension, severe dyspnea, and desaturation.Yasser's fibrillation (Sinusoidal atrial fibrillations) or mixed AF is a new cardiovascular discovery that balances AF and normal sinus rhythm.Multiple valve heart disease points to the simultaneous presence of several valvular anomalies.The multivessel disease is defined as significant stenosis (>70%) in 2 or more major coronary arteries of 2.5 mm diameter or more.Coronavirus disease 2019 presents an increased risk for ischemic heart disease after infection. Patient ConcernsAn 88-year-old, housewife widow Egyptian female patient was presented to the intensive care unit with hypertensive pulmonary edema, Yasser's fibrillation (Sinusoidal atrial fibrillations), variable ischemic heart disease, multiple valve heart disease, and suspected COVID-19 pneumonia. DiagnosisSympathetic crashing acute pulmonary edema (SCAPE) in the elderly with Yasser's fibrillation (Sinusoidal atrial fibrillations), multiple valvular disease, and possible multi-vessel disease in a suspected COVID pneumonia. InterventionsChest CT, electrocardiography, and oxygenation. OutcomesGood outcomes despite the existence of several remarkably serious risk factors were the results. LessonsThe association of COVID pneumonia with hypertensive crises, pulmonary edema, bilateral pleural effusion, variable-block atrial fibro flutter, elder age, female sex, sympathetic crashing acute pulmonary edema, diverse ischemic heart disease, Yasser's fibrillation, multivalvular disease, multivessel disease, and COVID-19 pneumonia are serious constellation risk factors.The management of a combination of sympathetic crashing acute pulmonary edema, diverse ischemic heart disease, Yasser's fibrillation, multivalvular disease, multivessel disease, and COVID-19 pneumonia in an older female may be complex.
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A 2024 study conducted a case report in Sympathetic Crashing Acute Pulmonary Edema, COVID-19 pneumonia, Yasser's Fibrillation, Multivalvular Disease (n=1). High-dose intravenous nitroglycerin and medical management was evaluated on Clinical and electrocardiographic improvement. High-dose intravenous nitroglycerin and medical management led to dramatic clinical improvement within 8 hours and discharge in 5 days in an 88-year-old female with SCAPE and suspected COVID-19.
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