A Shocking Outcome: Cardioversion-Induced Flash Pulmonary Edema

Atrial fibrillation (AF) is the most common major cardiac rhythm disorder in adults and causes considerable morbidity and mortality, particularly in elderly patients. We present the case of a 75-year-old female admitted for acute heart failure with a history of AF and recurrent heart failure exacerbations. Despite aggressive medical management with amiodarone and diuretics, the patient continued to deteriorate. The cardiology team recommended electrical cardioversion to re-establish a normal sinus rhythm. By doing so, the patient developed flash pulmonary edema after the procedure and required immediate intubation with mechanical ventilation. There was a need for tracheostomy to facilitate prolonged ventilatory support after some time. Over time, they were weaned off the ventilator and discharged home after full recovery. This case illustrates the challenges of managing AF in an elderly patient and the possible risks of flash pulmonary edema due to cardioversion.