What is the cause of pulmonary oedema after acute myocardial infarction? A case study

P G Raijmakers, J J Bax, A B Groeneveld, F C Visser, G J Teule, L G Thijs

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A patient is described with an acute myocardial infarction (AMI) and pulmonary oedema, necessitating mechanical ventilation, at a mean pulmonary capillary wedge pressure (PCWP) below 13 mmHg. The 67Ga-transferrin pulmonary leak index (PLI), a measure of microvascular permeability, was normal. A study of the course of the PCWP revealed intermittent elevations up to 22 mmHg, owing to intermittent mitral regurgitation. Pulmonary oedema after an AMI can thus be caused by pressure factors, even at sporadic elevations of PCWP, following intermittent, ischaemia-induced dysfunction of the posterior papillary muscle. Conversely, the measurement of a normal 67Ga-PLI may help to diagnose hydrostatic as opposed to permeability pulmonary oedema, if sporadic elevations of the PCWP are not recognised.

Original languageEnglish
Pages (from-to)591-2
Number of pages2
JournalIntensive care medicine
Issue number6
Publication statusPublished - Jun 1996


  • Capillary Permeability
  • Gallium Radioisotopes
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve
  • Mitral Valve Insufficiency/complications
  • Myocardial Infarction/complications
  • Papillary Muscles/physiopathology
  • Pulmonary Edema/diagnosis
  • Pulmonary Edema/etiology
  • Pulmonary Wedge Pressure
  • Respiration, Artificial
  • ischaemic heart disease

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