Severe cardiopulmonary complications of ketamine: Acute pulmonary Edema in a cardiac patient.

Ketamine use in the emergency department is more widespread than ever due to its favorable safety profile and combined analgesic and anesthetic properties. Its ability to stimulate the cardiovascular system via the sympathetic nervous system is particularly important, as patients can develop hemodynamic instability. However, concerns remain regarding the risk of decompensated cardiac function due to extreme tachycardia and severely elevated systemic blood pressure. In this case, a middle-aged male with a known history of coronary artery disease and congestive heart failure deteriorated significantly after ketamine was administered for sedation to facilitate a computed tomography pulmonary angiogram. He developed acute pulmonary edema and cardiogenic shock, requiring mechanical ventilation and inotropic support. Therefore, it is advisable to use ketamine with caution in patients with underlying heart failure. Further research is needed to establish a causal relationship between ketamine and cardiac decompensation leading to cardiogenic shock and pulmonary edema in selected patients.