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Case Reports in Cardiology
Volume 2019, Article ID 5746068, 4 pages
Case Report

Concurrent Negative-Pressure Pulmonary Edema (NPPE) and Takotsubo Syndrome (TTS) after Upper Airway Obstruction

1University of Virginia Health System, Charlottesville, VA, USA
2Cleveland Clinic Foundation, Cleveland, OH, USA

Correspondence should be addressed to Evan Harmon; ude.ainigriv@nomrahe

Received 31 December 2018; Revised 15 April 2019; Accepted 27 May 2019; Published 9 June 2019

Academic Editor: Manabu Shirotani

Copyright © 2019 Evan Harmon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Upper airway obstruction is a potentially life-threatening emergency often encountered in the acute care, perioperative, and critical care settings. One important complication of acute obstruction is negative-pressure pulmonary edema (NPPE). We describe two cases of acute upper airway obstruction, both of which resulted in flash pulmonary edema complicated by acute hypoxic respiratory failure. Though NPPE was suspected, these patients were also found to have Takotsubo syndrome (TTS). Neither patient had prior cardiac disease, and both subsequently had a negative ischemic workup. Because TTS is a condition triggered by hyperadrenergic states, the acute airway obstruction alone or in combination with NPPE was the likely explanation for TTS in each case. These cases highlight the importance of also considering cardiogenic causes of pulmonary edema in the setting of upper airway obstruction, which we suspect generates a profound catecholamine surge and places patients at increased risk of TTS development.