Acute pulmonary edema associated with placement of waist-high, custom-fit compression stockings

Compression stockings are a safe, noninvasive treatment for patients with s ymptomatic orthostatic hypotension due to autonomic nervous system dysfunct ion. In this report, we describe a 75-year-old man who had development of p ulmonary edema approximately 45 minutes after placement of compression stoc kings on the first postoperative day following a carotid endarterectomy, No sudden changes mere noted on an electrocardiogram or echocardiogram or in the cardiac isoenzymes associated with the pulmonary edema, The patient had a history of coronary artery disease, diabetes mellitus-induced autonomic nervous system dysfunction, and recent surgery near the carotid barorecepto r, All these factors may have limited his ability to compensate for a rapid increase in central blood volume. The temporal relationship of the patient 's respiratory distress to the placement of the compression stockings, in t he absence of laboratory findings of primary cardiac dysfunction, make stoc king-related fluid shift the likely precipitating event in the formation of acute pulmonary edema. This case suggests that compression stockings shoul d be used with caution in patients with limited cardiac reserve.