Transient ventricular dysfunction after an asphyxiation event: stress or hypoxia?
Mary E Valletta1, Ikram Haque, Faris Al-Mousily
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Shands Children Hospital at University of Florida, Gainesville, FL, USA. valleme@peds.ufl.edu
Summary
Pediatric patients experiencing airway obstruction and asphyxiation may develop myocardial dysfunction. Early screening for cardiac issues is crucial, especially when pulmonary edema is present.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Cardiovascular Physiology
Background:
- Acute upper airway obstruction can lead to asphyxiation, a critical event in pediatric care.
- Pulmonary edema is often attributed to noncardiogenic causes following airway obstruction.
- Myocardial dysfunction is an underrecognized complication in children after such events.
Observation:
- A case report details a 10-year-old girl with no prior medical history who developed acute myocardial dysfunction and flash pulmonary edema after airway obstruction.
- Diagnostic evaluations included serial echocardiograms, an exercise stress test, and coronary angiography.
- Biomarkers such as pro-brain natriuretic peptide, troponins, and creatine kinase-myocardial band (CK-MB) were monitored.
Findings:
- The patient exhibited signs of acute myocardial dysfunction and pulmonary edema.
- Cardiac biomarkers showed initial elevations, with troponin normalizing within 7 days.
- The patient was discharged on metoprolol, with ongoing cardiac monitoring planned.
Implications:
- Clinicians should maintain a high index of suspicion for acquired myocardial dysfunction in pediatric patients with severe hypoxic events, particularly those with pulmonary edema.
- Prompt cardiac evaluation is essential for appropriate management and support.
- Early consideration of adrenergic receptor blockade may be beneficial in managing pediatric myocardial dysfunction post-asphyxiation.
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