Adult respiratory distress syndrome in the course of acute myocardial infarction.

The diagnosis of adult respiratory distress syndrome (ARDS) has been made in our intensive coronary care unit in four patients during the course of acute myocardial infarction (AMI). In all four patients, the syndrome manifested itself either after resuscitation or after a transient hypotensive state. In two of the patients none of the conditions known to be possible etiologies of ARDS was present; in the third, smoke inhalation preceded; and in the fourth, aspiration followed the AMI. The clinical and x-ray pictures were indistinguishable from acute left heart failure, the PaO2 levels were about 40 mm Hg, and a low pulmonary arterial wedge pressure was measured in all cases. Positive end-expiratory pressure was used successfully, combined with other therapeutic measures, and three patients recovered from the ARDS. The association of ARDS and AMI carries a grave risk in view of the additional damage that may be caused by the severe hypoxemia to the already compromised myocardium. The AMI, if complicated by circulatory arrest, cardiogenic shock, or hypotension, seems to be an etiologic factor in the development of ARDS and it should be added to the growing list of conditions that may give rise to this new syndrome.