Pulmonary edema post-cardioversion: a potential calcium signalling problem

Abstract

The present report describes an unusual case of pulmonary edema after adenosine cardioversion of a supraventricular tachycardia. Despite a structurally normal heart, a 52-year-old woman presented with pulmonary edema on two separate occasions, having had her atrioventricular nodal re-entrant tachycardia terminated with 12 mg of intravenous adenosine. A third similar episode of tachycardia that was terminated with verapamil was not complicated by pulmonary edema.

Figure 1)

A Twelve-lead electrocardiogram at the time of presentation to the emergency room shows a narrow complex tachycardia at a rate of 190 beats/min; B Twelve-lead electrocardiogram postcardioversion with adenosine shows sinus rhythm at a rate of 86 beats/min

Figure 2)

Transesophageal short-axis (SAX) views acquired at the electrophysiological study showing end-diastolic area at: A Baseline sinus rhythm (SR) – end-diastolic area of 10 cm²; B Atrioventricular nodal re-entry tachycardia at a rate of 200 beats/min (BPM) – end-diastolic area of 7.5 cm²; C Within 1 min of cardioversion with adenosine (ADEN) – end-diastolic area of 11 cm²; D Five minutes postcardioversion with ADEN – end-diastolic area of 12 cm². Circ Circumference; HR Heart rate; SVT Supraventricular tachycardia

Figure 3)

Transesophageal short-axis (SAX) views acquired at the electrophysiological study showing end-systolic area at: A Baseline sinus rhythm (SR) – end-systolic area of 4.1 cm²; B Atrioventricular nodal re-entry tachycardia at a rate of 200 beats/min (BPM) – end-systolic area of 3.5 cm²; C Within 1 min of cardioversion with adenosine (ADEN) – end-systolic area of 3.8 cm²; D Five minutes postcardioversion with ADEN – end-systolic area of 6.6 cm². Circ Circumference; HR Heart rate; SVT Supraventricular tachycardia