Immersion Pulmonary Edema in the setting of Takotsubo Cardiomyopathy


  • Tara Mireille Reed University of Hawaii at Manoa John A. Burns School of Medicine



pulmonary edema, acute coronary syndrome, takotsubo cardiomyopathy, apical ballooning, immersion


Immersion Pulmonary Edema (IPE) is a unique medical condition being increasingly described in the medical literature as sudden-onset pulmonary edema in the setting of scuba diving and/or swimming. We report on three patients with unique presentations of IPE with associated development of Takotsubo cardiomyopathy (TTC). All three cases occurred in Oahu, Hawaii and were seen by the same cardiologist within a span of seven years. Each patient was scuba diving with sudden onset dyspnea with pulmonary edema on chest x-ray. Cardiac catheterization revealed no significant epicardial stenosis or thrombosis. EKGs showed typical evolution of symmetric T wave inversion. Wall motion abnormalities resolved.  IPE and TTC may occur together and may be more common than initially thought. Physical and emotional stressors are known to trigger TTC. TTC should be considered as a possible complication of IPE. Initial workup should include EKGs, cardiac enzymes, echocardiogram and, in the appropriate situation, cardiac catheterization. 


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