Pulmonary Oedema Flashcards
4 underlying causes of PO
- Increased LA pressure
- Increased pre-load (usually iatrogenic)
- Decreased oncotic pressure (this drops when pts are very unwell eg ITU)
- Endothelial injury (leaky, cytokines increase when unwell)
What can happen during extubation?
Loss of positive airway pressure = pulmonary oedema
What to do if someone is intubated in terms of albumin?
Start NG feeding when needed - do not want albumin to drop
What is the bodies response to trauma which can sometimes lead to fluid overload if we give too much fluids?
- Body releases ADH during stress
- = increased reabsorption of water and vasoconstriction
- Can lead to pulmonary oedema via increased pre-load (iatrogenic) cause
Causes of increased LA pressure which leads to PO
- LV diasolic failure
- Atrial fibrillation
- LV systolic failure
- Aortic stenosis (not sudden)
- Mitral regurgitation (sudden)
- Aortic regurgitation
- Mitral stenosis (not sudden)
- HTN
- Restrictive cardiomyopathy
- Myxoma
3 causes of left ventricular systolic failure
- Acute myocardial injury
- Myocardial infarction
- Myocarditis (seen with covid and adenoviruses)
Treatment for aortic stenosis
TAVI if not suitable for open heart surgery (catheter in femoral artery guided to put replacement valve over old one)
Causes (4) of sudden mitral regurgitation
- Infective endocarditis
- Lateral MI
- Anterior MI
- Snapped chordae tendinae - if have barlow valve
What happens in anterior MI to cause mitral regurgitation?
- Papillary muscles die from MI, causes chordae tendinae to not be taught, valve becomes flail
What happens for lateral MI to cause mitral regurge?
Posterior leaflet of valve is tethered up
Causes of acute aortic regurgitation
- Infective endocarditis
- Type A aortic dissection - causes pulling up of valve leaflet
Cause of mitral stenosis
Rheumatic fever
Pregnancy and mitral stenosis
- If go into labour - patient will die
- Placenta causes lots of fluid to re-enter blood stream?
- Will not be able to cope
Causes of secondary HTN in order of occurance
- Conns syndrome (high aldosterone)
- Cushings
- Pheochromocytoma
Also renal artery stenosis and co-arctation of aorta
5 causes of restrictive cardiomyopathy
- Amyloid (plasticine heart)
- Sarcoid (granulomatous)
- Haemochromotosis (iron heart)
- Loeffler endocarditis (helminths infection areas)
- B cell lymphoma
Myxoma causing PO - how?
- Myxomas are quite mobile
- Look like cauliflower
- Bounce in and out of mitral valve
- Parts can whizz off and cause stroke/limb ischaemia
- Mirrors mitral stenosis picture
Treatment myxoma
Surgery - that day or next day
Anaesthesia effects on Aortic stenosis
- Profound vasodilation
- = death for aortic stenosis
In AF why do you get increased LA pressure?
- Loss atrial systole
- Decrease diastole due to increased HR
- Irregular
Treatment for LVSF and LVDF
- O2 - high flow 60%
- IV Morphine 5-10mg or IV diamorphine 2.5-5mg
- IV furosemide 80mg
- GTN spray and GTN infusion 50mg in 50mls at rate of 0.1mls/hr (but online some say 1?)
- Antiemetic for morphine/diamorphine - metoclopramide 10mg or cyclizine 50mg
WHat do all the drugs (apart from antiemetic) do for treatment of LVDF and LVSF?
VASODILATE
Presentation of LVSF
- Pale
- High BP
- High RR
- Clammy
- Sitting up
- Visbily distressed
Adrenaline causes this - nO MORE inotropes needed
What do do if pulmonary oedema from LVSF andLVDF has not imrpoved with medications?
Consider CPAP - increases alveolar pressure pushes fluid back into vasculature
Worse - LVDF or LVSF?
LVDF is more likely to need CPAP - diastole is more important than systole
Severe aortic stenosis causing PO instead of LVDF/LVSF differences in presentation
- Severe aortic stenosis results in hypotension (or just on the edge of normal)
- Meaning if we VASODILATE massively we will cause them to have no BP and die
- Therefore we give furosemide and morphine but no nitrates usually
and treat cause - Dr Binns talked about bleeding the pt remember
