Pulmonary edema after cardioversion for paroxysmal atrial flutter - Left ventricular diastolic dysfunction induced by direct current shock

This report describes a patient with the pulmonary edema after cardioversio n for paroxysmal atrial flutter without organic heart disease. A 68-year-ol d man was admitted to hospital for paroxysmal atrial flutter. Antiarrhythmi c agents were not effective, and direct current cardioversion was performed on the 4th hospital day. Three hours after cardioversion, the patient comp lained of dyspnea, and a chest X-ray showed pulmonary edema. He responded t o oxygen, intravenous furosemide and drip infusion of nitroglycerine. Durin g tapering of the medication, his condition remained stable. The patient wa s discharged on the 7th day after admission. Echocardiographic findings ind icated that transient left ventricular diastolic dysfunction due to direct current shock was the most Likely cause of the lung edema.