Acute respiratory failure in pulmonary congestion: Case report and review

Abstract

Pulmonary Congestion (PC) is one of the most important causes of death in patients with heart failure which can be induced by a functional disorder no macroscopic appreciable in the examination of the heart. The authors present a case of edema and Respiratory Failure (RF) by PC in absence of clear and significant cardiac pathological elements in autopsy. Before the edema and then the PC act through an atelectasic mechanism that can be the cause of RF. The PC is often underestimated in the necropsy findings rather than being considered the main cause of death both in the case of objective cardiac injuries that in functional cardiac deaths.

Keywords

• Respiratory failure
• pulmonary congestion
• heart failure

References

1. 1. Kamm RC. Fatal arrhythmia following deodorant inhalation: case report. Forensic Sci 1975; 5: 91-93.
2. 2. Madias JE, Patel DC, Singh D. Atrial fibrillation in acute myocardial infarction: a prospective study based on data from a consecutive series of patients admitted to the coronary care unit. Clin Cardiol 1996; 19: 180- 186.
3. 3. Silva RG, Lima GG, Laranjeira A, et al. Risk factors, morbidity, and mortality associated with atrial fibrillation in the postoperative period of cardiac surgery. Arq Bras Cardiol 2004; 83: 105-110.
4. 4. Gheorghiade M, Zannad F, Sopko G, et al; International Working Group on Acute Heart Failure Syndromes. Acute heart failure syndromes: current state and framework for future research. Circulation 2005; 112: 3958-3968.
5. 5. Komajda M, Follath F, Swedberg K, et al; Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The EuroHeart Failure Survey programme--a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J 2003; 24: 464- 474.
6. 6. Gheorghiade M, Filippatos G, De Luca L, Burnett J. Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med 2006; 119: 3-10.
7. 7. Ross JS, Chen J, Lin Z, et al. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail 2010; 3: 97-103.
8. 8. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360: 1418-1428.

9. 9. Keenan PS, Normand SL, Lin Z, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes 2008: 29-37.
10. 10. Lloyd-Jones D, Adams RJ, Brown TM, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation 2010; 121: 46-215.
11. 11. Russo MJ, Gelijns AC, Stevenson LW, et al. The cost of medical management in advanced heart failure during the final two years of life. J Card Fail 2008; 14: 651-658.
12. 12. Giamouzis G, Kalogeropoulos A, Georgiopoulou V, et al. Hospitalization epidemic in patients with heart failure: risk factors, risk prediction, knowledge gaps, and future directions. J Card Fail 2011; 17: 54-75.
13. 13. Butler J, Kalogeropoulos A. Worsening heart failure hospitalization epidemic we do not know how to prevent and we do not know how to treat! J Am Coll Cardiol 2008; 52: 435-437.
14. 14. Zoccali C, Torino C, Tripepi R, et al. Pulmonary congestion predicts cardiac events and mortality in ESRD. J Am Soc Nephrol 2013; 24: 639-646.
15. 15. Adamson PB, Magalski A, Braunschweig F, et al. Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system. J Am Coll Cardiol 2003; 41: 565-571.
16. 16. Chaudhry SI, Wang Y, Concato J, Gill TM, Krumholz HM. Patterns of weight change preceding hospitalization for heart failure. Circulation 2007; 116: 1549-1554.
17. 17. Yu CM, Wang L, Chau E, et al. Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 2005; 112: 841-848.
18. 18. Picano E, Gargani L, Gheorghiade M. Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications. Heart Fail Rev 2010; 15: 63-72.
19. 19. Ware LB, Matthay MA. Clinical practice. Acute pulmonary edema. N Engl J Med 2005; 353: 2788- 2796.
20. 20. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149: 818-824.
21. 21. Gheorghiade M, Shin DD, Thomas TO, et al. Congestion is an important diagnostic and therapeutic target in heart failure. Rev Cardiovasc Med 2006; 7: 12-24.
22. 22. Fonarow GC; ADHERE Scientific Advisory Committee. The Acute Decompensated Heart Failure National Registry (ADHERE): opportunities to improve care of patients hospitalized with acute decompensated heart failure. Rev Cardiovasc Med 2003; 4: 21-30.
23. 23. Starling EH. On the Absorption of Fluids from the Connective Tissue Spaces. J Physiol 1896; 19: 312- 326.
24. 24. Fein A, Grossman RF, Jones JG, et al. The value of edema fluid protein measurement in patients with pulmonary edema. Am J Med 1979; 67: 32-38.
25. 25. Sprung CL, Rackow EC, Fein IA, Jacob AI, Isikoff SK. The spectrum of pulmonary edema: differentiation of cardiogenic, intermediate,and noncardiogenic forms of pulmonary edema. Am Rev Respir Dis 1981; 124: 718-722.
26. 26. West JB, Mathieu-Costello O. Strength of the pulmonary blood-gas barrier. Respir Physiol 1992; 88: 141-148.
27. 27. West JB, Tsukimoto K, Mathieu-Costello O, Prediletto R. Stress failure in pulmonary capillaries. J Appl Physiol (1985) 1991; 70: 1731-1742.
28. 28. Haupt MT. Cardiogenic pulmonary edema: an inflammatory disorder? Crit Care Med 2003; 31: 1282-1283.
29. 29. De Pasquale CG, Arnolda LF, Doyle IR, et al. Prolonged alveolocapillary barrier damage after acute cardiogenic pulmonary edema. Crit Care Med 2003; 31: 1060-1067.
30. 30. Cohen AB, Stevens MD, Miller EJ, et al. Neutrophilactivating peptide-2 in patients with pulmonary edema from congestive heart failure or ARDS. Am J Physiol 1993; 264: 490-495.
31. 31. Nakos G, Pneumatikos J, Tsangaris I, Tellis C, Lekka M. Proteins and phospholipids in BAL from patients with hydrostatic pulmonary edema. Am J Respir Crit Care Med 1997; 155: 945-951.
32. 32. Filippatos G, Leche C, Sunga R, et al. Expression of FAS adjacent to fibrotic foci in the failing human heart is not associated with increased apoptosis. Am J Physiol 1999; 277: 445-451.
33. 33. Parissis JT, Venetsanou KF, Mentzikof DG, et al. Tumor necrosis factor-alpha serum activity during treatment of acute decompensation of cachectic and non-cachectic patients with advanced congestive heart failure. Scand Cardiovasc J 1999; 33: 344-350.
34. 34. Birukov KG. Cyclic stretch, reactive oxygen species, and vascular remodeling. Antioxid Redox Signal 2009; 11: 1651-1667.
35. 35. Benumof JL, Wahrenbrock EA. Blunted hypoxic pulmonary vasoconstriction by increased lung vascular pressures. J Appl Physiol 1975; 38: 846-850.
36. 36. Gehlbach BK, Geppert E. The pulmonary manifestations of left heart failure. Chest 2004; 125: 669-682.