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[Acute pulmonary edema with pseudohypotension].

R Antonicelli¹, S Zarletti, L Amoroso

¹Unità Operativa di Cardiologia-UTIC Istituto INRCA Via della Montagnola, 81 60100 Ancona.

Italian Heart Journal. Supplement : Official Journal of the Italian Federation of Cardiology

|October 26, 2001

Summary

Severe hypotension in a myocardial infarction patient was caused by bilateral subclavian artery obstruction. This case highlights the importance of measuring blood pressure in all four limbs for accurate diagnosis of peripheral vascular disease.

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Area of Science:

Cardiology
Vascular Surgery
Diagnostic Imaging

Background:

A 69-year-old male presented with dyspnea and severe heart failure following a non-Q wave myocardial infarction.
Initial assessment revealed severe hypotension and bilateral lung crepitations, unresponsive to vasoactive drugs.

Observation:

Coronary angiography showed no significant coronary stenosis but elevated left ventricular systolic pressure (180/200 mmHg).
A computed tomographic spiral scan revealed bilateral subclavian artery obstruction originating from the aortic arch, with atheromatous substenosis of the right subclavian artery.

Findings:

Significant discrepancies in blood pressure measurements were noted: upper limbs < 90 mmHg systolic, while lower limbs > 220 mmHg systolic.
The findings indicated subclavian artery obstruction as the cause of the hemodynamic impairment and pressure differentials.

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Implications:

This case underscores the critical need for four-limb blood pressure measurement in patients with suspected peripheral vascular disease.
Accurate diagnosis and management of vascular conditions require comprehensive assessment beyond single-point blood pressure readings, especially in cases of hemodynamic instability.