In this case, a patient with no history of coronary artery disease presented with cardiogenic shock and eosinophilia. Her history of adult-onset asthma proved key to the eventual diagnosis.The patient, a 71-year-old woman, was transferred to our coronary intensive care unit from a local hospital emergency department for a non-ST-segment-elevation myocardial infarction and cardiogenic shock. She had visited the emergency department reporting dyspnea on exertion, orthopnea, lightheadedness, and a several-month history of worsening productive cough, weight loss, and fatigue. Previous antibiotic therapy had not improved her condition. The patient also had a history of Graves thyrotoxicosis, for which she had undergone radioiodine thyroid ablation therapy 10 years previously, adult-onset asthma, allergic sinusitis, nasal polyps, and persistent eosinophilia.
On the patient’s arrival at the emergency department, her temperature was 38°C; heart rate, 112 beats/min; blood pressure, 80/33 mm Hg; respiratory rate, 24 breaths/min; O2 saturation (on room air), 88%. She was started on intravenous dobutamine and epinephrine infusions and placed on O2 (6 L/min). Although her blood pressure and O2 saturation improved, a chest radiograph demonstrated bilateral pulmonary edema, and an electrocardiogram showed loss of anterior forces, left atrial delay, and ST segment depression (Figure 1). A chest computed tomography (CT) scan was negative for pulmonary embolism but revealed diffuse, small pulmonary nodules and interstitial and alveolar edema. As that point, the patient was transferred to our coronary intensive care unit.
To read this article in its entirety, please visit our website.
— — Omeed Zardkoohi, MD, Robert Hobbs, MD, Carmela D. Tan, MD
This article originally appeared in November 2011 issue of The American Journal of Medicine.
