Anaphylaxis can be associated with hemodynamic shock, which requires the early initiation of adrenaline as part of its management. Cardiogenic pulmonary edema is a frequent entity in emergency services with increased mortality in patients with acute coronary syndrome. The case report presents the case of a 55-year-old male patient who entered the emergency department with a non-ST-segment elevation myocardial infarction (NSTEMI) associated to pulmonary edema and anaphylaxis. During his stay in the emergency room, he had an anaphylactic reaction to dipyrone (metamizole) used for pain control. The patient presented signs of acute pulmonary edema, a hypertensive urgency after the use of adrenaline for the management of anaphylaxis.  There was doubt as to whether the dyspnea was of anaphylactic or cardiogenic origin, so an emergency ultrasound was performed, which suggested a bilateral pattern B.  This allowed timely management of ventilatory failure with systemic nitrates, diuretics, and oxygen therapy, which controlled blood pressure and resolved ventilatory failure. Subsequently, he was transferred to an institution with a hemodynamic service for the management of NSTEMI. We highlight the utility of emergency ultrasonography for immediate decision-making and the low prevalence of anaphylactic reaction in a patient with NSTEMI leading to acute pulmonary edema.

Pulsatile blood flow in a subject-specific human aortic arch and its major branches is studied computationally for a peak Reynolds number of 1553 and a Womersley number of 22.74. The aortic geometry is constructed from the CT-scan images of a subject. The aorta has out-of-plane curvature and significant area variation along the flow direction. A physiologically representative pulsatile velocity waveform is applied as boundary condition at the inlet of the aorta. The primary velocity profiles are skewed towards the inner wall of the ascending aorta during the entire cardiac cycle. In the decelerating phase, reverse flow is noted along the inner wall and the magnitude of maximum velocity is about 50 % of the peak flow condition. Flow separation is observed in the inner wall of the ascending aorta during the decelerating and reverse flow phases of the cardiac cycle. In the accelerating phase, however, flow separation does not occur. The major observation of the present work is the existence of complex and asymmetrical vortical flow structures which are not observed either in simple curved pipes or in idealized aortic arch computational studies. The relative strength of the secondary flow with respect to the primary flow is quantified by means of Relative Secondary Kinetic Energy whose highest value is evaluated to be 1.202 occurring near the entrance of the right carotid artery during the maximum reverse flow condition. High values of wall shear stress is observed at distal of the left and right subclavian arteries, the bifurcation of brachiocephalic artery between right subclavian artery and right carotid artery, and proximal inner wall of descending aorta during the cardiac cycle. The wall shear stress at the bifurcations of the branches are low and oscillatory and generally correlates with the preferential sites for atherosclerosis. The flow structures on the aorta wall are explicitly highlighted by the limiting streamlines. The application of limiting streamlines to clearly elucidate the complex on-wall flow structures is one of the key contributions of the present study. During the decelerating and reverse flow phases several critical points are observed on the aortic wall. These complex flow structures vanish during the accelerating phase. The observations made in the present study will be helpful in creating accurate and clinically useful computational models.