Type II Myocardial Infarction and Stress Cardiomyopathy Secondary to Inhaled Foreign Body (Garden Pea)

Abstract

Abstract A foreign body aspiration is an unusual event in the adult population, outside of known risk factors such as neurological disease. It typically presents as "cough (67%), dyspnoea (28%), chest pain, cyanosis, stridor or obstruction" and "wheezing (12.7%) and haemoptysis (23.3%)". The authors present the case of inhaled foreign body (pea) in a 69-year-old lady, without underlying risk factors for aspiration. On admission, she was tachypnoeic and unable to speak in full sentences. Her Computerised tomography (CT) scan showed ground-glass changes and potentially superimposed infective changes. Whilst awaiting transfer for bronchoscopy, she developed severe respiratory distress with cardiovascular compromise (new left bundle branch block (LBBB), tachycardia and hypertension). She was intubated in extremis and commenced on noradrenaline. Her angiogram showed mild non-obstructive disease, and she was diagnosed with a type two myocardial infarction and stress-induced cardiomyopathy. The pea was later removed on intensive care via flexible-bronchoscopy. Learning points include the potential for patients with a foreign body to acutely deteriorate, hence the need for urgent bronchoscopic removal and the potential to develop myocardial ischaemia secondary to acute respiratory distress.