Author/Authors :
Harmon, Evan University of Virginia Health System, Charlottesville, VA, USA , Estrada, Sebastian University of Virginia Health System, Charlottesville, VA, USA , Koene, Ryan J. Cleveland Clinic Foundation, Cleveland, OH, USA , Mazimba, Sula University of Virginia Health System, Charlottesville, VA, USA , Kwon, Younghoon University of Virginia Health System, Charlottesville, VA, USA
Abstract :
Upper airway obstruction is a potentially life-threatening emergency often encountered in the acute care, perioperative, and critical
care settings. One important complication of acute obstruction is negative-pressure pulmonary edema (NPPE). We describe two
cases of acute upper airway obstruction, both of which resulted in flash pulmonary edema complicated by acute hypoxic
respiratory failure. Though NPPE was suspected, these patients were also found to have Takotsubo syndrome (TTS). Neither
patient had prior cardiac disease, and both subsequently had a negative ischemic workup. Because TTS is a condition triggered
by hyperadrenergic states, the acute airway obstruction alone or in combination with NPPE was the likely explanation for TTS
in each case. These cases highlight the importance of also considering cardiogenic causes of pulmonary edema in the
setting of upper airway obstruction, which we suspect generates a profound catecholamine surge and places patients at
increased risk of TTS development.
