Pulmonary Edema

Question 1

Essentials of Diagnosis:

Acute onset or worsening of dyspnea at rest
Tachycardia, diaphoresis, cyanosis
Pulmonary rales, rhonchi, expiratory wheezing
Radiograph shows interstitial and alveolar edema with or without cardiomegaly
Arterial hypoxemia
Cardiogenic cause vs non-cardiac cause

Answer 1

Pulmonary Edema

Question 2

Typical causes of acute disease:

Acute myocardial infarction or severe ischemia.
Exacerbation of chronic heart failure.
Acute volume overload of the LV (Valvular regurgitation).
Mitral stenosis.
In most patients with cardiogenic dx, an underlying cardiac abnormality can usually be detected clinically, by the ECG, CXR, or echocardiogram.

Answer 2

Pulmonary Edema

Question 3

General Considerations:

Most common presentation in developed countries is one of acute or subacute deterioration of chronic heart failure.
Precipitated by discontinuation of medications
Excessive salt intake
Myocardial ischemia
Tachy-arrhythmia’s (especially rapid atrial fibrillation)
Concurrent infection
Often there is preceding volume overload with worsening edema and progressive shortness of breath for which earlier intervention can usually avoid the need for hospital admission

Answer 3

Pulmonary Edema

Question 4

Non-cardiac causes of:

Intravenous opioids
Increased intracerebral pressure
High altitude
Sepsis
Shock

Answer 4

Pulmonary Edema

Question 5

Physical Findings:

Severe dyspnea
Production of pink, frothy sputum
Diaphoresis
Cyanosis

You will hear all Rales are present in all lung fields, as are generalized wheezing and rhonchi
May appear acutely or sub- acutely in the setting of chronic heart failure
May be the first manifestation of cardiac disease (usually acute myocardial infarction)

Answer 5

Acute Pulmonary Edema

Question 6

Imaging Findings:

1.Chest radiograph:
- Pulmonary vascular redistribution
- Blurriness of vascular outlines
- Increased interstitial markings
- Butterfly pattern of distribution of alveolar edema

2.EKG

3.Cardiogram ECCO

The heart may be enlarged or normal in size.
Assessment of cardiac function by echocardiography is important

Answer 6

Pulmonary Edema

Question 7

Treatment

• High Oxygen is delivered by mask to obtain adequate oxygenation. Monitor O2 Sat.
• n full-blown dx, the patient should be placed in a sitting position with legs dangling over the side of the bed.

If respiratory distress remains severe, endotracheal intubation and mechanical ventilation may be necessary.

Primary Tx: remove the liquid

Diuretics:
1. *Furosemide (Lasix), 20 - 80mg IV/IM/PO
2. Bumetanide (Bumex), 1 mg IV/PO
3. Morphine 2-8 mg IV- if MI
4. Nitrate therapy: Sublingual nitroglycerin -BP elevated

Answer 7

Pulmonary Edema

Question 8

Disposition:

In patients without prior heart failure, evaluation should include echocardiography and in many cases cardiac catheterization and coronary angiography.

Patients with acute decompensation of chronic heart failure should be treated to achieve a euvolemic state and have their medical regimen optimized.

Answer 8

Pulmonary Edema

Question 9

Complications:

Bronchospasm may occur in response to disease and may itself exacerbate hypoxemia and dyspnea.

Treatment with inhaled SABA Beta-adrenergic agonists or intravenous aminophylline may be helpful.

Answer 9

Pulmonary Edema