Pulmonary Edema Cliffnotes Flashcards
Define Cardiogenic Pulmonary Edema
Excessive fluid in lung tissues or alveoli caused by increased pulmonary capillary pressure resulting from increased left sided heart pressure
Causes of Cardiogenic pulmonary edema?
- Left sided heart failure
- Aortic stenosis
- mitral valve stenosis
- systemic hypertension
- Alveolar capillary membrane leakage caused by injury (i.e ARDS)
What happens hemodynamic parameters are affected by cardiogenic pulmonary edema?
PCWP and PAP increase due to backup of fluid into pulmonary capillaries
What 2 forces maintain fluid balance within the capillaries?
- Plasma oncotic pressure (pressure trying to keep fluid in the caps)
- Capillary hydrostatic pressure (pressure trying to push fluid out of caps)
- Oncotic pressure is normally higher than hydrostatic pressure keeping fluid in the caps
Pathophysiology of Cardiogenic pulmonary edema?
aka what are the 4 components that occur to impede normal airway function?
TLDR; Cardiac issues lead to increased pressure in the pulmonary veins forcing fluid into the lungs
- Blood from the heart backs up into pulmonary circulation, capillary hydrostatic pressure increases above plasma oncotic pressure into interstitial spaces
- Excess fluid overwhelms the lymphatic system and it drains into alveoli which can results in decreased CL
- Airway resistance increases bc of excess fluid in airways
- A-a gradient widens as a result of intrapulmonary shunting, and v/q mismatch results
Clinical signs and symptoms of cardiogenic pulmonary edema
- Dyspnea (2 types)
- Productive cough with thin, pink frothy secretions
- fine crackles (early) -> coarse crackles (late)
- Tachypnea
- Cyanosis
- Diaphoresis (sweating)
- Distended neck veins
- tachycardia/other arrythmias
What are 2 types of dyspnea associated with cardiogenic pulmonary edema?
Both are relieved by sitting upright/semi fowlers
- Orthopnea; SOB while lying down
- Paroxysmal nocturnal dyspnea (occurs during sleep, causing awakening)
What is happening when crackles go from fine to coarse?
- fine: Early days; alveoli filling with fluid
- Coarse: late, fluid moves into the airways
CxR for cardiogenic pulmonary edema?
- Increased vascular markings
- Interstitial edema
- Enlarged heart shadow
- Bat wing appearance
- Kerley B lines
Treatments for cardiogenic Pulmonary edema?
- O2 admin (based on PaO2)
- CPAP/BiPAP
- Vent support w/PEEP
- Shallow sxn to maintain patent airway
- Morphine
- Diuretics (furosemide)
- Cardiac glycosides
Diagnostic tools to identify Cardiogenic Pulmonary Edema?
- Echocardiogram
- CxR
- Blood tests (like BNP) can help identify heart problems
Define non cardiogenic pulmonary edema?
Direct lung injury, Inflammation, or damage resulting in increased permeability of the AC membrane. Leaky capillary walls
can be a result of:
- Infections (like pneumonia)
- Toxins
- Trauma
- High altitude exposure
Mechanism of non cardiogenic pulmonary edema?
Increased capillary permeability in the lungs, allowing fluid to leak into alveolar space despite normal hydrostatic pressure
Key differences between non cardiogenic and cardiogenic pulmonary edema?
- Cardio has increased PCWP and/or PAP. Non cardio would have normal parameters
- Low protein levels suggest cardiogenic (transudate), while high suggest non cardiogenic (exudate)
How do treatments differ between cardiogenic and non cardiogenic pulmonary edema?
- Cardiogenic requires heart failure medications and PAP
- Non cardiogenic edema may involve treating lung injury or infection
Why is Cardiogenic PE transudate even though it involves cardiac failure?
The capillaries stay intact, the fluid is just plasma filtrate aka transudate
Why is non cardiogenic PE exudate even though it involves lung injury?
In non cardiogenic the membrane is damaged, allowing proteins and cells to leak= exudate
