Acute pulmonary edema associated with direct current cardioversion in a structurally normal heart

Area of Science:

• Cardiology
• Critical Care Medicine

Background:

• Direct current cardioversion (DCC) is a standard treatment for supraventricular tachyarrhythmias.
• While generally safe, serious complications like thromboembolism and intracranial hemorrhage are known risks.
• Postcardioversion pulmonary edema is a rare but reported complication, particularly in patients with underlying heart disease.

Observation:

• This report details a patient with a structurally normal heart who developed acute pulmonary edema following DCC.
• The patient exhibited no signs of myocardial injury on electrocardiogram or cardiac biomarkers.
• The pulmonary edema resolved within four days of treatment with intravenous diuretics.

Findings:

• Acute pulmonary edema can occur after direct current cardioversion even in patients with structurally normal hearts.
• The absence of cardiac injury markers suggests non-ischemic mechanisms may contribute to this complication.
• Prompt treatment with diuretics can effectively manage postcardioversion pulmonary edema.

Implications:

• Clinicians should be aware of the potential for pulmonary edema following DCC, irrespective of pre-existing cardiac conditions.
• Further research is needed to elucidate the exact incidence and underlying mechanisms of postcardioversion pulmonary edema.
• This case underscores the importance of vigilant monitoring for adverse events after cardioversion procedures.