What is SCAPE in Cardiovascular Medicine?

What is SCAPE in Cardiovascular Medicine?

SCAPE is an acronym for sympathetic crash acute pulmonary edema, which can typcially occur in Pickering syndrome with renal artery stenosis [1]. Another term for transient acute pulmonary edema which occurs in renal artery stenosis is flash pulmonary edema. SCAPE is the extreme end of the spectrum of acute pulmonary edema and needs urgent management in the emergency room [2]. Excessive release of catecholamines may increase the permeability of pulmonary capillaries and facilitate flash pulmonary edema [3]. Endothelial dysfunction secondary to excessive activity of renin-angiotenisn-aldosterone axis, impaired synthesis of nitric oxide and increased endothelin levels may also contribute to the genesis of SCAPE.

Flash pulmonary edema in renal artery stenosis is more likely to occur when there is bilateral renal artery stenosis. Lack of the normal diurnal variation of blood pressure and wide pulse pressure have been considered as risk factors for development of flash pulmonary edema [3]. There is an abrupt redistribution of fluid in the lungs and they can recover rapidly when promtly treated. Non invasive ventilation and intravenous nitrates have been mentioned as the mainstay of treatment. Though loop diuretics are often used, the evidence in favour of them is said to be lacking, as in case of morphine [2]. High altitude pulmonary edema (HAPE) is also considered to be a form of SCAPE due to pulmonary capillary stress failure [4].

References

1. Shrimal P, Sahu AK, Mathew R, Bansal A. Pickering syndrome: a rare presentation in emergency department. BMJ Case Rep. 2021 Feb 9;14(2):e239421. doi: 10.1136/bcr-2020-239421. PMID: 33563668; PMCID: PMC7875303.
2. Agrawal N, Kumar A, Aggarwal P, Jamshed N. Sympathetic crashing acute pulmonary edema. Indian J Crit Care Med. 2016 Dec;20(12):719-723. doi: 10.4103/0972-5229.195710. PMID: 28149030; PMCID: PMC5225773.
3. Rimoldi SF, Yuzefpolskaya M, Allemann Y, Messerli F. Flash pulmonary edema. Prog Cardiovasc Dis. 2009 Nov-Dec;52(3):249-59. doi: 10.1016/j.pcad.2009.10.002. PMID: 19917337.
4. Krasney JA. A neurogenic basis for acute altitude illness. Med Sci Sports Exerc. 1994 Feb;26(2):195-208. doi: 10.1249/00005768-199402000-00010. PMID: 8164537.