CHEST Guidelines-A-Woman-in-Her-90s-With-Respiratory-Distress-After (2)

A-Woman-in-Her-90s-With-Respiratory-Distress-After (2)

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The document discusses a clinical case involving a woman in her 90s who developed respiratory distress after undergoing transcatheter aortic valve replacement (TAVR) and pacemaker implantation. The patient, with a history of aortic stenosis, atrial fibrillation, and bladder cancer, faced complications post-procedure, including complete heart block necessitating a pacemaker. She experienced dyspnea with a new oxygen requirement. Her vitals included low blood pressure and a normal heart rate, while the examination revealed tachypnea and lung crackles indicative of possible pulmonary issues.<br /><br />The likely diagnosis, as determined by the handheld ultrasound, is cardiogenic pulmonary edema. The ultrasound ruled out several potential post-procedural complications such as pneumothorax, pericardial effusion, paravalvular aortic regurgitation, and right-sided ventricular dysfunction. The presence of extravascular lung water and elevated filling pressures contributed to the pulmonary edema diagnosis. Further investigations identified no aortic regurgitation or significant issues with the pacemaker leads, while pulmonary embolism and coronary ischemia were considered unlikely due to normal ultrasound findings regarding right ventricular function and previous coronary angiography results.<br /><br />The patient was treated with diuretics, which improved her condition by reducing fluid overload. Finally, the discussion highlights the utility of handheld ultrasound in rapidly diagnosing and managing complex cases by augmenting the physical examination. This case emphasizes that common diagnoses like pulmonary edema should not be overlooked despite the possibility of multiple complications. The case showcases the importance of quick bedside diagnostic tools like handheld ultrasonography in managing critically ill patients, enabling expedited triage and treatment planning.

Keywords

transcatheter aortic valve replacement

pacemaker implantation

cardiogenic pulmonary edema

handheld ultrasound

aortic stenosis

atrial fibrillation

dyspnea

diuretics

pulmonary embolism

bedside diagnostic tools