Valvular Heart Disease Presenting as Sympathetic Crashing Acute Pulmonary Edema (SCAPE) Phenomenon: A Diagnostic and Management Paradigm

Harish Ashok; Jurgen Shtembari; Eliz Achhami; Suman Gaire; Dhan B Shrestha; Tilak Joshi

doi:10.7759/cureus.32352

Valvular Heart Disease Presenting as Sympathetic Crashing Acute Pulmonary Edema (SCAPE) Phenomenon: A Diagnostic and Management Paradigm

Cureus. 2022 Dec 9;14(12):e32352. doi: 10.7759/cureus.32352. eCollection 2022 Dec.

Authors

Harish Ashok¹, Jurgen Shtembari², Eliz Achhami³, Suman Gaire², Dhan B Shrestha², Tilak Joshi²

Affiliations

¹ Department of Internal Medicine, Ross University School of Medicine, Bridgetown, BRB.
² Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA.
³ Department of Internal Medicine, Sukraraj Tropical & Infectious Disease Hospital, Kathmandu, NPL.

Abstract

Sympathetic crashing acute pulmonary edema (SCAPE) is an acute decompensated heart failure due to sympathetic overflow. SCAPE is usually triggered by acute insults with an underlying substrate such as long-standing hypertension, chronic heart failure, and valvular heart disease. We present a case of SCAPE in a 91-year-old female due to underlying multivalvular heart disease. Because of severe acute presentation, SCAPE should be identified early, and management should be urgently done to decrease the need for invasive ventilation and prolonged hospitalization.

Keywords: acute heart failure; bipap; nitroglycerin; sympathetic crashing acute pulmonary edema; valvular heart disease.

Publication types

Case Reports