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UNUSUAL PRESENTATION OF AMIODARONE INDUCED PULMONARY TOXICITY
1261 JACC April 5, 2016 Volume 67, Issue 13
FIT Clinical Decision Making UNUSUAL PRESENTATION OF AMIODARONE INDUCED PULMONARY TOXICITY Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision Making: Arrhythmias and Clinical Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1264-316 Authors: Ayman Mohamed Elbadawi, Damanpaul Sondhi, Yousuf Kyeso, Rochester General Hospital, Rochester, NY, USA Background: Pulmonary toxicity is a serious adverse effect of amiodarone.
Case: 62-year-old male presenting with 7 days duration of acute dyspnea. His past medical history included hypertension and coronary artery disease. He was diagnosed with atrial fibrillation (AF) 2 months before presentation, when he was started on amiodarone 200 mg daily and apixaban. At baseline he had average functional capacity. On presentation he was in rate controlled AF, with fine crackles bilaterally on chest auscultation. Dyspnea progressively worsened and his oxygen demand increased from room air to non-re-breather mask within 4 days. He further worsened and needed to be on Bi-level positive airway pressure (BiPAP), with eminent intubation.
Decision Making: Chest x-ray showed bilateral ground glass infiltrates, CT chest was consistent with interstitial pneumonitis. Differential diagnosis included infective pneumonitis, pulmonary hemorrhage and amiodarone toxicity. Apixaban was held and he was started on broad spectrum antibiotics and steroids. Antibiotics were discontinued after sputum culture was negative. Over 2 weeks patient responded to high dose steroids with decrease of oxygen demands to nasal oxygen at 2 L/hour Conclusions: This case highlights an unusual presentation for amiodarone induced pulmonary toxicity, with acute respiratory failure occurring over a week duration after 2 month of starting amiodarone. Also a daily dose of 200 mg is unusual to cause amiodarone induced pulmonary toxicity.
FIT Clinical Decision Making UNUSUAL PRESENTATION OF AMIODARONE INDUCED PULMONARY TOXICITY Poster Contributions Poster Area, South Hall A1 Monday, April 04, 2016, 9:45 a.m.-10:30 a.m. Session Title: FIT Clinical Decision Making: Arrhythmias and Clinical Electrophysiology Abstract Category: Arrhythmias and Clinical EP Presentation Number: 1264-316 Authors: Ayman Mohamed Elbadawi, Damanpaul Sondhi, Yousuf Kyeso, Rochester General Hospital, Rochester, NY, USA Background: Pulmonary toxicity is a serious adverse effect of amiodarone.
Case: 62-year-old male presenting with 7 days duration of acute dyspnea. His past medical history included hypertension and coronary artery disease. He was diagnosed with atrial fibrillation (AF) 2 months before presentation, when he was started on amiodarone 200 mg daily and apixaban. At baseline he had average functional capacity. On presentation he was in rate controlled AF, with fine crackles bilaterally on chest auscultation. Dyspnea progressively worsened and his oxygen demand increased from room air to non-re-breather mask within 4 days. He further worsened and needed to be on Bi-level positive airway pressure (BiPAP), with eminent intubation.
Decision Making: Chest x-ray showed bilateral ground glass infiltrates, CT chest was consistent with interstitial pneumonitis. Differential diagnosis included infective pneumonitis, pulmonary hemorrhage and amiodarone toxicity. Apixaban was held and he was started on broad spectrum antibiotics and steroids. Antibiotics were discontinued after sputum culture was negative. Over 2 weeks patient responded to high dose steroids with decrease of oxygen demands to nasal oxygen at 2 L/hour Conclusions: This case highlights an unusual presentation for amiodarone induced pulmonary toxicity, with acute respiratory failure occurring over a week duration after 2 month of starting amiodarone. Also a daily dose of 200 mg is unusual to cause amiodarone induced pulmonary toxicity.