[Skip to Content]

Quiz

Clinical Pharmacy and Pharmacology

Acute Respiratory Distress Following Percutaneous Coronary Intervention of Osteal Occlusion of Left Main Coronary Artery

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Cardiology

Published Online: April 12, 2023

JAMA Cardiology Clinical Challenge

Article Information and Disclosures

Mochamad Yusuf Alsagaff, MD, PhD¹;

Makyhan Jibril Al Farabi, MD¹;

Arief Bakhtiar, MD²

Author Affiliations

¹Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga—Dr Soetomo General Hospital, Surabaya, Indonesia
²Department of Pulmonology, Faculty of Medicine, Universitas Airlangga—Dr Soetomo General Hospital, Surabaya, Indonesia

Read article on JAMA Network

Read Case Take Quiz Answer

A man in his late 50s was released from a tertiary hospital with an anterior ST-elevation myocardial infarction and cardiogenic shock with onset 6 days before admission. On admission, vital signs showed blood pressure as 98/66 mm Hg while receiving dobutamine and norepinephrine from the referral hospital, a regular heart rate of 90 beats per minute, a respiratory rate of 22 breaths per minute, peripheral oxygen saturation 96% nasal oxygen at 3 L per minute, and a temperature of 36.7° C. Echocardiography showed reduced left ventricle systolic function (estimated ejection fraction, 34%) and hypokinesia of the anteroseptal, anterior, anterolateral, and septal walls. Lung ultrasound demonstrated multiple B-lines in both lung fields. Diagnostic coronary angiography revealed a total occlusion in the left main coronary artery. Percutaneous coronary intervention (PCI) was successful in opening the osteal left main and drug-eluting stents were placed in the left main and left anterior descending arteries.

Take Quiz

Please finish quiz first before checking answer.

A man in his late 50s was released from a tertiary hospital with an anterior ST-elevation myocardial infarction and cardiogenic shock with onset 6 days before admission. On admission, vital signs showed blood pressure as 98/66 mm Hg while receiving dobutamine and norepinephrine from the referral hospital, a regular heart rate of 90 beats per minute, a respiratory rate of 22 breaths per minute, peripheral oxygen saturation 96% nasal oxygen at 3 L per minute, and a temperature of 36.7° C. Echocardiography showed reduced left ventricle systolic function (estimated ejection fraction, 34%) and hypokinesia of the anteroseptal, anterior, anterolateral, and septal walls. Lung ultrasound demonstrated multiple B-lines in both lung fields. Diagnostic coronary angiography revealed a total occlusion in the left main coronary artery. Percutaneous coronary intervention (PCI) was successful in opening the osteal left main and drug-eluting stents were placed in the left main and left anterior descending arteries.

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Corresponding Author: Mochamad Yusuf Alsagaff, MD, PhD, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga—Dr Soetomo General Hospital, Mayjen Prof Dr Moestopo Street No. 47, Surabaya 60132, Indonesia (yusuf_505@fk.unair.ac.id).

Published Online: April 12, 2023. doi:10.1001/jamacardio.2023.0503

Conflict of Interest Disclosures: None reported.

References

Wolkove N , Baltzan M . Amiodarone pulmonary toxicity. Can Respir J. 2009;16(2):43-48. doi:10.1155/2009/282540 PubMed Google Scholar Crossref

Feduska ET , Thoma BN , Torjman MC , Goldhammer JE . Acute amiodarone pulmonary toxicity. J Cardiothorac Vasc Anesth. 2021;35(5):1485-1494. doi:10.1053/j.jvca.2020.10.060 PubMed Google Scholar Crossref

Papiris SA , Triantafillidou C , Kolilekas L , Markoulaki D , Manali ED . Amiodarone. Drug Saf. 2010;33(7):539-558. doi:10.2165/11532320-000000000-00000 PubMed Google Scholar Crossref

Colby R , Geyer H . Amiodarone-induced pulmonary toxicity. JAAPA. 2017;30(11):23-26. doi:10.1097/01.JAA.0000524713.17719.c8 PubMed Google Scholar Crossref

Ashrafian H , Davey P . Is amiodarone an underrecognized cause of acute respiratory failure in the ICU? Chest. 2001;120(1):275-282. doi:10.1378/chest.120.1.275 PubMed Google Scholar Crossref

Yamada Y , Shiga T , Matsuda N , Hagiwara N , Kasanuki H . Incidence and predictors of pulmonary toxicity in Japanese patients receiving low-dose amiodarone. Circ J. 2007;71(10):1610-1616. doi:10.1253/circj.71.1610 PubMed Google Scholar Crossref

Berry MF , D’Amico TA , Onaitis MW . Use of amiodarone after major lung resection. Ann Thorac Surg. 2014;98(4):1199-1206. doi:10.1016/j.athoracsur.2014.05.038 PubMed Google Scholar Crossref

Camus P . Interstitial lung disease from drugs, biologics, and radiation. In: Schwartz MI , King TE , eds. Interstitial Lung Dis. 5th ed. People’s Med Publ House; 2011:637.

Okayasu K , Takeda Y , Kojima J , et al. Amiodarone pulmonary toxicity. Intern Med. 2006;45(22):1303-1307. doi:10.2169/internalmedicine.45.1800 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.