Acute Pulmonary Edema

Question 1

Worst( most severe) form of CHF

Answer 1

Acute pulmonary edema( rapid fluid accumulation in lungs)

Question 2

Acute shortness of breath with rales, JVD, S3 gallop, edema, orthopnea. May be ascites& enlargement of liver/spleen from chronic passive congestion of R side of heart

Answer 2

Acute pulmonary edema

Question 3

What is the best initial test?

Answer 3

• brain natriuretic peptid
( if ds not clear, N= exclude CHF)
• chest Xray

Question 4

Chest X ray: vascular congestion, filling of blood vessels toward head( cephalization of flow), flow mostly at base bs of gravity, enlargement of heart, effusion

Answer 4

acute pulmonary edema

Question 5

Engorged pulmonary veins. Cefalization of flow

Answer 5

Pulmonary edema

Question 6

Oximetry/arterial blood gas during acute pulmonary edema

Answer 6

• Hypoxia
• respiratory alkalosis from hyperventilation
• CO2 leaves more easily than oxygen enters

Question 7

If acute pulmonary edema is from arrhythmia fix it fast with

Answer 7

Cardioversion

Question 8

Acute pulmonary edema must be done on all pts

Answer 8

Echo KG- distinguish systolic from diastolic

Question 9

Acute pulmonary edema. Best initial step in management

Answer 9

Intravenous furosemide

Question 10

Preload reduction. Acute pulmonary edema tx

Answer 10

Oxygen, loop diuretics( furosemide or bumetinide), morphine, nitrates

Question 11

Preload reduction hasn’t been effective. Next step?

Answer 11

Positive inotropic agents
• Dobutamine in ICU
• Amrinone and milrinone
• Phosphodiesterade inh that perform the same role( incr. contractility, decrease afterload)

Question 12

No benefit in acute setting, too slow, needs several weeks to work

Answer 12

Digoxin

Question 13

Afterload reduction in acute pulmonary edema

Answer 13

ACEi, ARB, used on discharge, nitroprusside in ICU, hydralazine alternate for ACE/ARB