Dipyridamole-associated shock and pulmonary edema

Area of Science:

• Cardiology
• Clinical Pharmacology
• Critical Care Medicine

Background:

• Dipyridamole is commonly used for pharmacologic stress testing in myocardial scintigraphy.
• Hypotension is a known adverse effect of intravenous dipyridamole.
• Mechanisms of dipyridamole-induced shock are not well-characterized.

Observation:

• A 73-year-old woman developed fulminant shock and noncardiogenic pulmonary edema minutes after intravenous dipyridamole administration.
• Cardiovascular collapse required vasopressors and mechanical ventilation.
• Echocardiography suggested hypovolemic shock with right-heart underfilling, not cardiogenic dysfunction.

Findings:

• This case presents the first report of severe noncardiogenic pulmonary edema associated with intravenous dipyridamole.
• Echocardiographic findings support a noncardiogenic, likely hypovolemic, mechanism for the observed shock.
• Causality assessment indicated probable relation between dipyridamole and the cardiopulmonary collapse.

Implications:

• Clinicians should be aware of the potential for severe noncardiogenic cardiopulmonary adverse events with intravenous dipyridamole.
• This case expands understanding of dipyridamole's hemodynamic effects beyond vasodilation.
• Further investigation into the pathophysiology of dipyridamole-induced shock and edema is warranted.