(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Pulmonary edema is usually divided into cardiogenic and noncardiogenic pulmonary edema. The patient was treated for pneumonia before admission and the CT of the lung suggested no absorption of the lesion and no relief of shortness of breath. From the images and the onset of the disease, pulmonary edema is indeed easily confused with pneumonia, and after the patient was admitted to the hospital for treatment of dilated cardiomyopathy, the pulmonary edema was significantly absorbed and the shortness of breath was relieved.
Basic information】Male, 38 years old
Disease Type】Pulmonary edema, dilated cardiomyopathy
Hospital】The First Hospital of Harbin Medical University
Date of consultation】May 2022
Treatment plan】Medication (cefmetazole sodium for injection + metoprolol tartrate tablets + spironolactone tablets)
Treatment Period】Hospitalization for 8 days
Effectiveness of treatment】The disease has been controlled, and all indicators are improving
I. Initial consultation
The patient had been cold before the onset of the disease. Before admission, she had a cough and coughed up a small amount of yellow mucous sputum, followed by chest tightness and shortness of breath, which gradually worsened and prevented her from lying down, and she woke up at night with swelling of both lower limbs, palpitations and decreased urine output. The patient did have symptoms of lower respiratory tract infection, yellow sputum decreased after out-of-hospital anti-inflammatory treatment, but shortness of breath was not relieved, the course of the disease was accompanied by weight gain, the infection was considered to be a wasting disease, combined with the patient’s lung imaging lesions, the diagnosis of pneumonia could not fully explain the patient’s dyspnea and weight gain, to consider the patient may be combined with pulmonary edema and cardiac insufficiency.
II. Treatment history
The patient had a history of hypertension in the past, but did not pay attention to and regularly applied antihypertensive drugs, and had not participated in physical examination. The patient was admitted to the hospital with coughing, coughing a small amount of yellow sputum, still feeling shortness of breath at rest, blood pressure measured 183/98 mmhg, clear consciousness, cyanosis of lips and mouth, after admission, the patient was given complete cardiac ultrasound, emergency cardiac enzyme + TNI + BNP, blood gas analysis, electrocardiography, biochemical series of tests. Cardiac ultrasound suggested dilated cardiomyopathy, and the patient was diagnosed with pulmonary edema and tensor cardiomyopathy. The patient was considered to have pulmonary edema, which was caused by the aggravation of acute cardiac insufficiency caused by infection, and the control of infection needed to improve cardiac function at the same time. The patient chose a treatment plan based on the above examination results. The patient was instructed to take oxygen to improve his dyspnea symptoms, and was given anti-infective treatment with cefmetazole sodium for injection, and was asked to consult the cardiology department. The patient was instructed to take metoprolol tartrate tablets and spironolactone tablets orally to improve myocardial remodeling, cardiac strengthening and diuretic treatment, and was instructed to pay attention to rest and avoid straining, and the patient’s shortness of breath was relieved and his cough and sputum were reduced after 1 week of treatment.
III. Treatment effect
After adopting these treatment measures, the patient’s blood gas analysis showed that the lack of oxygen was significantly improved, the cough and coughing symptoms were significantly reduced, the sputum volume was significantly reduced, the inflammation index was basically normalized, the blood pressure was normalized, the weight was reduced, the patient’s mobility and quality of life were improved, and the patient’s condition was controlled and all the indexes were improving after 8 days of hospitalization, so the patient was discharged.
IV. Notes
We are glad that after treatment, the patient’s condition is under control and all indicators are improving, but subsequent patients should pay attention to the following points.
1.The amount of activity should be limited on weekdays, and appropriate sports and exercises can be done to increase the rest time to relieve the symptoms.
2.Patients are advised to consume nutritious, softer, more easily absorbed and less irritating food. A salt-restricted diet is more important and do not consume too much high-fat, high-protein and high-heat food.
3. Monitor daily fluid intake and urine volume, monitor body weight and blood pressure, avoid anxiety, take medication regularly, improve sleep quality, quit bad habits, improve immunity, keep warm, prevent colds and respiratory infections, and follow up with cardiology regularly.
V. Personal insight
Pulmonary edema is more likely to be misdiagnosed as pneumonia in the diagnosis of clinical diseases, and the possibility of pulmonary edema is considered only after repeated anti-infection treatment is ineffective. After treatment, the patient’s condition has been controlled, and all indicators are improving. The patient should be followed up after discharge, and blood pressure and weight should be monitored to grasp the health status from small details.