Pulmonary Edema with Wide-Complex Tachycardia

Abstract

A 58-year-old woman came to the emergency department with severe shortness of breath. Her symptoms had developed late in the evening after several days of Increasing cough and dyspnea on exertion. There was no chest pain or palpitation. She had had hypertension for the past 10 years, treated intermittently with metoprolol and hydrochlorothiazide. A month before this presentation she had discontinued those medications because her supply ran out.

She was an obese woman in moderate respiratory distress. Blood pressure was 190/120 mm Hg, pulse was 140 beats per minute and regular, respirations were 32 per minute, temperature was 37.1°C, and arterial oxygen saturation was 96%. Her skin was cool and moist. The arterial pulses were small in volume but symmetrical. Crackles and coarse rhonchi were heard throughout the chest. Cardiac examination showed rapid regular rhythm with three sounds per cycle, probably reflecting the presence of an S4 or a summation gallop. No variability in heart sounds or arterial pulse volume was noted. The jugular venous pressure did not appear to be elevated, and there was no peripheral edema.